J Korean Orthop Assoc.  2012 Aug;47(4):299-304. 10.4055/jkoa.2012.47.4.299.

Sarcoidosis Presenting as Knee Pain

• Min KD
• Hwang SH
• Lee YS
• Lee BI

• KMID: 2185378
• DOI: http://doi.org/10.4055/jkoa.2012.47.4.299

Abstract

Sarcoidosis is a multisystem granulomatous disease of unknown etiology with variable manifestations, which may affect virtually any organ. Muscular sarcoidosis is a rare entity, and among this group of muscular lesions, the mass-like muscular sarcoidosis type is extremely rare. We reported a muscular sarcoidosis case that presented with right knee pain and described the clinical results with an added review of the relevant literature.

Keyword

sarcoidosis; knee pain; magnetic resonance imaging

MeSH Terms

Knee
Magnetic Resonance Imaging
Sarcoidosis

Figure

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  Figure 1 (A, B) An axial and coronal T2-weighted magnetic resonance (MR) images show hyperintensity (white arrow head) in the vastus medialis muscle fiber. (C) An axial T2-weighted MR image shows ovoid nodules (white arrows) scattered throughout muscles of the lower extremities (dark star sign). (D) T2-weighted coronal MR image shows an inner stripe of decreased signal intensity and outer stripes of significantly increased signal intensity in the tibialis anterior muscle (B, white arrow) and the proximal medial gastrocnemius muscle (three stripe sign, white arrow).

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  Figure 2 (A) A chest radiograph shows perihilar nodular densities suggesting bihilar lymphadenopathy. (B, C) Dynamic chest computed tomography shows homogeneously enhancing enlarged lymph nodes at both lower paratrachea, both hila and subcarina.

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  Figure 3 (A, B) Longitudinal and short axial scans through the right medial gastrocnemius muscle show an inner structure of increased echogenicity and outer area of decreased echogenicity. (C, D) Longitudinal and short axial color doppler sonographies show plenty of vascularity in the proximal medial gastrocnemius muscle.

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  Figure 4 (A) Numerous epitheloid cells formed noncaseating granulomas (H&E, ×40). (B) A histopathologic specimen of the needle aspiration showed numerous epithelioid histiocytes arranged in sheets and a few multinucleated giants cells of Langhans-type (H&E, ×200).

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