PMC7170123_01
Chest HRCT, transverse plane, initial examination. At the aortic arch level, a subpleural nodule in the apical S1+2 segments of the left upper lobe with pleural thickening in the adjacent area. Subpleural lesions are quite typical for necrotizing sarcoid granulomatosis (NSG) without predilection for upper or lower lobe involvement. In the right lung dorsally, a slight thickening of the pleura and of the major interlobar fissure
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F1
Multiple subpleural nodular opacities, the largest 13mm in diameter, were seen on the chest CT (Figures 1, 2, 3).
Chest HRCT, initial examination, transversal plane at the level of lower lobes shows spherical nodules with smooth edges, with no apparent spiculations extending into the surrounding pulmonary parenchyma. A larger, 18 mm nodule in the S10 segment of the right lower lobe; a smaller one, 11 mm, in the S9 segment of the left lower lobe. Among frequent findings in NSG are nodular lesions with smooth or slightly irregular borders that may exhibit cavitations
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F2
Multiple subpleural nodular opacities, the largest 13mm in diameter, were seen on the chest CT (Figures 1, 2, 3).
Chest HRCT, transverse plane, two-month follow-up. A tiny 'consolidation' of the pulmonary parenchyma with isolated calcifications and fibrous streaks extending towards the thickened pleura is present at the upper left lobe level in S1+2. The original S1+2 nodule adjacent to the pleura has partially regressed - a sign of a certain development of the disease over time
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F3
Multiple subpleural nodular opacities, the largest 13mm in diameter, were seen on the chest CT (Figures 1, 2, 3).
Histopathological findings. Microscopically, confluent non-caseating granulomas with extensive necrosis are seen in the lung parenchyma. The granulomas are of the sarcoid type, palisaded by Langerhans-type giant cells and mononuclear lymphohistiocytes with central necrosis. Another typical finding is the presence of vasculitis, usually granulomatous, and a large zone of necrosis. a) Large zone of necroris (x50); b) granulomatous vasculitis (x100); c) confluent granulomas and vasculitis (x 100).
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F4
Special staining on mycobacteria and fungi are negative (Figure 4).
Chest HRCT, transverse plane, two-month follow-up. Compared with the initial examination, multiple nodules in the pulmonary parenchyma, predominantly in subpleural localization, have partially or completely disappeared. An 8 mm nodule (previously 18 mm) is present in S10 of the left lower lobe (indicated by the arrow)
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F5
Three months later, regression of nodular opacities on chest HRCT was observed (Figure 5).