In-111 octreotide SPECT/CT in the early diagnosis of pulmonary sarcoidosis: A case report

Abstract

Sarcoidosis is a granulomatous disease of unknown etiology. At present the best diagnostic imaging procedure to assess stage and activity of sarcoidosis is controversial. We report the case of a 50-year-old male admitted with a history of dyspnea and fatigue with past medical history negative for smoking, occupational and environmental risk factors. Physical examination, routine blood tests, and pulmonary function tests were normal except for hypercalciuria. A chest radiograph showed bilateral hilar lymphadenopathy. Single photon emission computed tomography and/or computed tomography (SPECT and/or CT) In-111 Octreotide (Octreoscan) scintigraphy confirmed morphologic involvement of bilateral hilar lymph nodes and a mediastinoscopy biopsy specimen provided diagnosis of pulmonary sarcoidosis (stage 0). This clinical case shows the effectiveness of In-111 Octreotide SPECT and/or CT in the early diagnosis of pulmonary sarcoidosis.

Keywords: In-111 Octreotide (Octreoscan); Positron-emission tomography (PET); Radiological imaging; Sarcoidosis; Single photon emission computed tomography and/or computed tomography (SPECT and/or CT).

Fig. 1

SPECT and/or CT Octreoscan scintigraphy showed morphologic involvement of bilateral hilar lymph nodes which also had an increased uptake (14.3 U.I.), compared to the rest of the lung (7.8 U.I., normal value ≤10 U.I.). Chest radiograph showing initial hilar adenopathy confirmed by CT, In-111 Octreotide and SPECT and/or CT.

Fig. 2

Photomicrograph of the biopsy sample stained with hematoxylin and eosin showed a confluent sarcoid granulomata pattern in thoracic lymph nodes at 20x (A) and 200x (B) magnification. Features showed multinuclear giant cells, mononuclear phagocytes, and lymphocytes. No necrosis was present.