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Skeletal Sarcoid
Osseous Manifestations of Sarcoidosis
General Considerations
- Radiographic evidence of osseous involvement occurs in about 5% of patients with sarcoidosis
- Arthralgia in patients with sarcoid may occur in up to 1/3 of patients
- Patients are usually between 20-40, more frequently women
- Typically affects multiple joints
- Most often affects hands, feet and ankles (the latter in acute form)
- Lesions in long bones, skull or spine are rare
- Often occurs in association with pre-existing pulmonary and/or skin lesions such as lupus pernio
- Purplish, indurated macules or papules on the face considered classic for sarcoid
- May occasionally be presenting manifestation of sarcoid
Clinical Findings
- Frequently asymptomatic
- Joint manifestations include
- Pain
- Soft tissue swelling
- Soft tissue nodules (granulomas)
- Erythema nodosum, especially in acute form
Imaging Findings
- Usually bilateral and symmetric
- Middle and distal phalanges of hands and feet most frequent sites of involvement
- Tends to spare the wrists
- Distal portions of small bones of hands and feet tend to be affected first
- Patterns of osseous sarcoidosis
- Small, cortical, punched-out lytic lesions, usually well-corticated, in the phalangeal heads are most common manifestation
- Some been described as heart-shaped as in this case
- Reticular (permeative) pattern produces a lace-like (driftwood) pattern of destruction
- Acro-osteosclerosis of the terminal phalanges (bone stones)
- Not specific but can occur in up to 50% of patients with sarcoid of hands
- May represent healing phase
- Acro-osteolysis resembling scleroderma
- Bone destruction with pathologic fractures
- Usually with soft tissue swelling but without periosteal reaction
- Subperiosteal resorption resembling hyperparathyroidism
- Soft tissue nodules
- Although plain films are usually adequate to make the diagnosis, MR may show additional or unsuspected lesions in bone and soft tissues
Chronic Osseous Manifestations of Sarcoid |
Punched-out lytic lesions |
Lace-like destruction |
Bone stones (acro-osteosclerosis) |
Bone destruction with/without pathologic fracture |
Acro-osteolysis |
Subperiosteal resorption resembling hyperparathyroidism |
Differential Diagnosis
Treatment
- Corticosteroids may decrease pain and swelling
- Bone changes are irreversible in chronic form
Prognosis
- Chronic osseous involvement is usually associated with diseases of other organs and has a poor prognosis
Sarcoid of feet. Frontal radiographs of both feet show multiple punched-out lytic lesions (red arrows) (one heart-shaped-white arrow), mostly in the proximal phalanges of both feet. There is also bone destruction and pathologic fractures of both third toes and the distal right 5th toe (black arrows).
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Radiographic, angiographic and radionuclide manifestations of osseous sarcoidosis.
Yaghmai, I. RadioGraphics Volume 3, Number 3 September 1983 pp. 375
Sarcoidosis: A Primary Care Review. Belfer, M; Stevens, R. American Family Physician. December 1998
Sarcoid of bones www.Gentili.net
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