title: Clinical and radiological features of extra-pulmonary sarcoidosis: a pictorial essay.
abstract: The aim of this manuscript is to describe radiological findings of extra-pulmonary sarcoidosis. Sarcoidosis is an immune-mediated systemic disease of unknown origin, characterized by non-caseating epitheliod granulomas. Ninety percent of patients show granulomas located in the lungs or in the related lymph nodes. However, lesions can affect any organ. Typical imaging features of liver and spleen sarcoidosis include visceromegaly, with multiple nodules hypodense on CT images and hypointense on T2-weighted MRI acquisitions. Main clinical and radiological manifestations of renal sarcoidosis are nephrolithiasis, nephrocalcinosis, and acute interstitial nephritis. Brain sarcoidosis shows multiple or solitary parenchymal nodules on MRI that enhance with a ring-like appearance after gadolinium. In spinal cord localization, MRI demonstrates enlargement and hyperintensity of spinal cord, with hypointense lesions on T2-weighted images. Skeletal involvement is mostly located in small bone, showing many lytic lesions; less frequently, bone lesions have a sclerotic appearance. Ocular involvement includes uveitis, conjunctivitis, optical nerve disease, chorioretinis. Erythema nodosum and lupus pernio represent the most common cutaneous manifestations encountered. Sarcoidosis in various organs can be very insidious for radiologists, showing different imaging features, often non-specific. Awareness of these imaging features helps radiologists to obtain the correct diagnosis.
  
  
  CONCLUSIONS
  • Systemic sarcoidosis can exhibit abdominal, neural, skeletal, ocular, and cutaneous manifestations. • T2 signal intensity of hepatosplenic nodules may reflect the disease activity. • Heerfordt's syndrome includes facial nerve palsy, fever, parotid swelling, and uveitis. • In the vertebrae, osteolytic and/or diffuse sclerotic lesions can be found. • Erythema nodosum and lupus pernio represent the most common cutaneous manifestations.
authors.affiliation: Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy. spalmucci@sirm.org.
authors.forename: Stefano
authors.initials: S
authors.lastname: Palmucci
authors.affiliation: Regional Centre for Interstitial and Rare Lung Diseases, Department of Clinical and Molecular Biomedicine, University Hospital Policlinico-Vittorio Emanuele, Via Santa Sofia 78, 95123, Catania, Italy.
authors.forename: Sebastiano Emanuele
authors.initials: SE
authors.lastname: Torrisi
authors.affiliation: Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy.
authors.forename: Daniele Carmelo
authors.initials: DC
authors.lastname: Caltabiano
authors.affiliation: Regional Centre for Interstitial and Rare Lung Diseases, Department of Clinical and Molecular Biomedicine, University Hospital Policlinico-Vittorio Emanuele, Via Santa Sofia 78, 95123, Catania, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Puglisi
authors.affiliation: Unit of Diagnostic and Interventional Radiology, ARNAS Garibaldi, Catania, Italy.
authors.forename: Viviana
authors.initials: V
authors.lastname: Lentini
authors.affiliation: Section of Radiological Sciences, DIBIMEF, University Hospital "Paolo Giaccone" University of Palermo, Palermo, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Grassedonio
authors.affiliation: Regional Centre for Interstitial and Rare Lung Diseases, Department of Clinical and Molecular Biomedicine, University Hospital Policlinico-Vittorio Emanuele, Via Santa Sofia 78, 95123, Catania, Italy.
authors.forename: Virginia
authors.initials: V
authors.lastname: Vindigni
authors.affiliation: Department of G. F. Ingrassia, Section of Neurosciences, University Hospital Policlinico-Vittorio Emanuele, Via Santa Sofia 78, 95123, Catania, Italy.
authors.forename: Ester
authors.initials: E
authors.lastname: Reggio
authors.affiliation: Regional Centre for Interstitial and Rare Lung Diseases, Department of Clinical and Molecular Biomedicine, University Hospital Policlinico-Vittorio Emanuele, Via Santa Sofia 78, 95123, Catania, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Giuliano
authors.affiliation: Dermatology Clinic, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Micali
authors.affiliation: Department of G.F. Ingrassia, Institute of Pathology, University Hospital Policlinico-Vittorio Emanuele, Catania, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Caltabiano
authors.affiliation: Neuroradiology and Radiology, Anthea Hospital Bari, Gruppo Villa Maria, Puglia, Italy.
authors.forename: Cosma
authors.initials: C
authors.lastname: Andreula
authors.affiliation: Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy.
authors.forename: Pietro Valerio
authors.initials: PV
authors.lastname: Foti
authors.affiliation: Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy.
authors.forename: Giovanni Carlo
authors.initials: GC
authors.lastname: Ettorre
authors.affiliation: Department of Radiology, Kings College Hospital Foundation Trust, Denmark Hill, London, UK.
authors.forename: Simon Lf
authors.initials: SL
authors.lastname: Walsh
authors.affiliation: Regional Centre for Interstitial and Rare Lung Diseases, Department of Clinical and Molecular Biomedicine, University Hospital Policlinico-Vittorio Emanuele, Via Santa Sofia 78, 95123, Catania, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Vancheri
keywords: Granulomatous disease, chronic; Magnetic resonance imaging; Multidetector computed tomography; Positron-emission tomography; Sarcoidosis