Atypical and uncommon presentation of sarcoidosis with long segment involvement of the pharynx and larynx: Case report and review of literature

Pharynx/Larynx is an uncommon site of involvement of sarcoidosis. Isolated pharyngo-laryngeal sarcoidosis is extremely rare as most of the cases are part from multiorgan and systemic sarcoidosis. Pharyngo-laryngeal sarcoidosis is usually asymptomatic which could be attributed to its rare incidence as many cases pass unnoticed. Symptomatic cases usually present with hoarseness of voice. As the disease progress, the patient can present with progressive dysphagia to solid and liquid with globus sensation. We described an atypical involvement of almost the whole length of the pharynx with extension into the larynx in a 51-year-old woman who presented with progressive dysphagia. To the best of our knowledge, this is the first report to describe the imaging features of sarcoidosis involvement of the pharynx and larynx.

Comprehensive radiological features of laryngeal sarcoidosis: cases series and systematic review

PURPOSE

To comprehensively summarize the characteristic radiological findings of laryngeal sarcoidosis.

METHODS

We reviewed patients with laryngeal sarcoidosis who underwent computed tomography (CT) and/or magnetic resonance imaging (MRI) and included 8 cases from 8 publications that were found through a systematic review and 6 cases from our institutions. Two board-certified radiologists reviewed and evaluated the radiological images.

RESULTS

Almost all cases exhibited supraglottic lesions 13/14 (92.9%) and most of them involved aryepiglottic folds (12/13, 92.3%), epiglottis (11/14, 78.6%), and arytenoid region (10/14, 71.4%). Most lesions were bilateral (12/14, 85.7%). All cases showed well-defined margins and a diffuse swelling appearance (14/14, 100%). Non-contrast CT revealed a low density (4/5, 80%). The contrast-enhanced CT showed a slight patchy enhancement predominantly at the margin of the lesion in most cases (12/13, 92.3%). In one case, T2-weighted images showed high signal intensity peripherally and low signal intensity centrally (1/1, 100%). Gadolinium-enhanced MRI showed moderate heterogeneous enhancement predominantly at the margin of the lesion (2/2, 100%). In one case, diffusion-weighted imaging showed intermediate signal intensity; the apparent diffusion coefficient value was 2.4 × 10^-3 mm²/s. The larynx was the only region affected by sarcoidosis in 57.1% (8/14) of the cases. Involvement of the neck lymph nodes and distant organs was observed in 4/14 (28.6%) patients, respectively.

CONCLUSION

We summarized the CT and MRI findings of patients with laryngeal sarcoidosis. Knowledge of these characteristics is expected to facilitate prompt diagnosis and appropriate management.