Roentgenologic Changes in Sarcoid and Related Lesions

Abstract

THE disease known as Boeck's sarcoid is characterized primarily by the formation of nodules in the cutaneous and subcutaneous tissues. The skin over these areas has a telangiectatic appearance. The distribution of the lesions and the histologic picture are distinctive. Closely related to this lesion are the diseases known as DarierRoussy sarcoid, lupus pernio, and erythema induratum. In this group of related diseases there are sometimes accompanying systemic complaints and more or less characteristic lesions in organs other than the skin. Among the systemic lesions that have been described are fibrocystic changes in the bones, infiltration in the lungs, adenopathy of the cervical lymph nodes, splenomegaly, tonsillar swelling, iritis, and infiltrations in the mucous membranes of the upper air passages. Various hypotheses with regard to the etiology of this disease have been advanced: for example, that it is due to the bacillus of tuberculosis; that it is a separate disease entity, or that several factors are involved. In certain cases the bacillus of tuberculosis has been isolated from the lesions in the skin, and definite tuberculous lesions have often been found. In other cases there is no evidence of tuberculosis and even the tuberculin test gives a negative reaction. The fact that a general lymphadenopathy sometimes occurs suggests the possibility that the condition is related to lymphoma. The favorable results reported in certain cases following roentgen-ray treatment would tend to substantiate this view. It is Voorhoeve's belief that, since the central nervous system is often involved, the lesions in the bones are of a trophic nature. He cited, to support this view, observations at necropsy in a case originally reported by Winkler in which there were definite changes in the nervous system. Because of the fact that Boeck's sarcoid with visceral involvement is seldom fatal, pathologic descriptions of the visceral lesions are meager. Schaumann (13, 14) studied the bones histologically in cases in which the finger or toe had been amputated and reported that the findings strongly resembled those found in bones involved in lymphomatous processes. Hence he called sarcoid with visceral involvement “benign lymphogranuloma.” The patient with sarcoid of the lung described by Bernstein, Konzlemann, and Sidlick (2) came to necropsy and lesions were found in the bronchial mucous membrane resembling sarcoid as it occurs in the skin. The questions of etiology and the relation of the various types of sarcoid to one another are for the dermatologists to settle. Goeckerman (6) has given a very complete summary of the present opinion on these questions. It is, however, important for the roentgenologist to know that in the cases diagnosed as belonging to the sarcoid group there are roentgenologic signs which are more or less characteristic of the condition. These occur as changes in the bones and in the lungs.