Skeletal involvement is seen in approximately 5% - 10% of patients with sarcoidosis. The phalanges in the hands and feet are most frequently affected. Radiologic features are characterized by cystic or lacelike appearance which is bilateral in distribution, usually at the ends in small bones (hands and feet). The articular spaces are usually intact, unless extensive lesions (punched-out lesions) develop. Calcification is absent. A subcutaneous soft-tissue mass or tenosynovitis may also be present.
Tuft fracture in the ring finger. Bilateral lace-like reticular trabecular pattern in the proximal phalanges of the middle finger, proximal, middle and distal phalangs of the ring finger and ring and litlle finger metacarpal bones.
Oblique
Bilateral hilar adenopathy
40 yo F with hand injury.
Sarcoidosis is a systemic disorder of unknown cause that is characterized by noncaseating granulomas with proliferation of epithelioid cells. Sarcoidosis commonly affects young and middle-aged patients, with a slightly higher prevalence in women. The disease has distinct geographic and racial predilections, with African-Americans, Swedes, and Danes appearing to be most commonly affected.
Bilateral hilar lymphadenopathy is the most common radiologic finding.
Skeletal involvement is seen in approximately 5%-10% of patients with sarcoidosis. The phalanges in the hands and feet are most frequently affected. Radiologic features are characterized by cystic or lacelike appearance which is bilateral in distribution, usually at the ends in small bones (hands and feet). The articular spaces are usually intact, unless extensive lesions (punched-out lesions) develop. Calcification is absent. A subcutaneous soft-tissue mass or tenosynovitis may also be present. As a rule, the recognition of typical lesions is relatively easy if the patient presents with multisystem features of sarcoidosis. However, diagnosis may be difficult if the bone lesion occurs in the absence of the typical pulmonary and extrapulmonary features of sarcoidosis. Many clinical disorders, including tuberculosis, histoplasmosis, coccidoidomycosis, leprosy, brucellosis, syphilis, Wegener granulomatosis, eosinophilic granuloma, multiple myeloma, lymphoma and metastasis can cause bony lesions indistinguishable from those due to sarcoidosis. Fortunately, in daily practice only a few diseases need to be differentiated from sarcoidosis. Most of the time chest radiograph and possibly laboratory tests along with bony findings are sufficient to make a diagnosis. In difficult cases a bone biopsy helps demonstrating noncaseating granuloma.
Suggesting reading:
T. Koyama, H. Ueda, K Togashi, S. Umeoka, M. Kataoka, and S. Nagai. Radiographics. 2004; 24:87-104. Radiologic Manifestations of Sarcoidosis in Various Organs.
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