Dr. Chitrangada Jitendra
Radiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am in an awful condition and have been diagnosed with sarcoidosis. I have a range of neurological pain and inflammatory symptoms. I need someone to assess a couple of scans that I have.
I have nasal congestion for five years, with lots of mucus in the chest and throat. Last two years, I have some neurological symptoms like teeth pain, head pain, extreme dizziness, abnormal bodily movements, shaking in head and tremors, extreme ringing sound in the head, vertigo, sight problems, sensitivity to light, muscle loss, neck pain, tingling, balance problems, urinary retention at times, foamy urine. I also have an unstable pulse, both on the higher and lower resting pulse range.
My ACE values at the higher range. I know I have sarcoidosis. This is a diagnosis given to me by a couple of doctors. I want to know my prognosis. I suspect pulmonary fibrosis. That has also mentioned in one report. I kindly ask you to provide me with as much detailed assessment as possible, like all abnormalities in the tissue, lymph nodes, parenchyma, numbers, and location and sizes of the nodules. Which of them are calcified? And the condition of the blood vessels, if they might be calcified or other conditions concerning them.
Hello,
Welcome to icliniq.com.
By the clinical images you sent (attachment removed to protect patient identity), I can understand the degree of the inflammatory response in your body tissues and concerns associated with it.
I am unable to access your radiology images and would request you to reload them.
If you are on any medications and if not, I would recommend consulting a rheumatologist at the earliest please as timely treatment can reverse the damage and prevent irreparable tissue changes, especially in the lungs (fibrosis).
I am waiting for your prompt response.
Patient's Query
Thank you doctor,
I have attached the links to my images. I want your opinions regarding the degree of damages and suggestions for optimal treatment.
Hello,
Welcome back to icliniq.com.
Thank you for uploading the images (attachment removed to protect patient identity).
The chest images show mediastinal lymph nodes due to known sarcoidosis but no other acute features.
The MRI (magnetic resonance imaging) of the brain shows a few lacunar infracts in gangliocapsular region. No diffuse parenchyma change or major finding. No large infarcts or bleed. No mass lesions. No hydrocephalus.
I would still emphasize the need to consult a rheumatologist who are better equipped with managing sarcoidosis with multisystem involvement and can control disease progression.
In terms of imaging, if you have any further questions, please feel free to discuss.
Patient's Query
Thank you doctor,
Can you just be a little bit more specific? What is the danger of having bigger infarcts or expansion of already existing infarcts in my brain in the near future? And how common is that seen in connection with sarcoidosis or other vasculitis diseases?
Could you please describe a bit the condition in my lungs when it comes to the nodules, and how big they are, which ones are calcified, and the findings in thyroid.
Hello,
Welcome back to icliniq.com.
I will explain each point in detail.
Infarcts: Systemic vasculitis lead to small vessel infarcts and extremely rare to cause larger infarcts or any large territory involvement as they only affect small vessels. Also, there are often new vessels to supply collaterals due to slow and long standing process rather than an acute phenomenon.
Lungs: The soft density lung nodules are only a few mm, largest up to 4 mm. The calcified ones are generally stable, but soft density need follow up. These nodules represent granulomas, which is a feature of sarcoidosis.
Thyroid: The thyroid nodule is cystic and in keeping with a colloid cyst. If there is any interval change in size, an ultrasound imaging can be planned and depending on the results, further investigation like FNA (fine needle aspiration) can be done.
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Radiology
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