Imaging Findings of Concomitant Pulmonary and Central Nervous System Sarcoidosis: A Case Report

BACKGROUND: Sarcoidosis is a multisystem idiopathic granulomatous disorder characterized by the development of noncaseating infiltrative granulomas in various body organs. The central nervous system (CNS) is one of the sites to be affected by sarcoidosis. We present a case of sarcoidosis with concomitant involvement of lung and CNS with emphasis on neuroimaging findings. CASE: A 45-year-old Ethiopian male patient was sent to our radiology department at Tikur Anbessa Specialized Hospital for chest computed tomography (CT) and brain Magnetic resonance imaging (MRI) evaluation for an indication of panhypopituitarism, nasal congestion, and decreased vision. The chest CT reveals the perilymphatic distribution of multiple soft tissue attenuating pulmonary nodules which is a pattern seen in sarcoidosis. The brain MRI also revealed thickening and gadolinium enhancement of hypothalamus/optic chiasm which is also a common site of involvement in neurosarcoidosis. The nasal biopsy finding of granulomatous inflammation with the above imaging findings supports the diagnosis of sarcoidosis. CONCLUSION: As sarcoidosis is a systemic disease that can affect any organ in the body, multimodality imaging is important in the diagnosis of sarcoidosis. Brain MRI with gadolinium contrast is a preferred imaging modality that can assess different patterns and areas of CNS involvement in sarcoidosis.