In this lecture, we review a comprehensive case of systemic sarcoidosis in a 48-year-old male presenting with progressive shortness of breath and a right pulmonary mass. The FDG PET/CT findings demonstrate the classic multiorgan involvement of sarcoidosis, which can closely mimic metastatic malignancy.

The discussion highlights the importance of recognizing characteristic imaging patterns, particularly the “lambda sign,” lymph node distribution, and pulmonary parenchymal findings, as well as the need for biopsy correlation and appropriate cardiac preparation when evaluating for sarcoid involvement.

Learning Objectives

By the end of this lecture, participants will be able to:

• Recognize the characteristic PET/CT distribution pattern of sarcoidosis (“lambda sign,” symmetric hilar and mediastinal nodes).
• Identify pulmonary features such as peribronchovascular consolidation, “galaxy sign,” and fissural thickening.
• Understand that sarcoidosis may present with lytic or sclerotic bone lesions that mimic metastases.
• Appreciate the importance of whole-body evaluation, including adrenal and extrathoracic involvement.
• Apply appropriate cardiac preparation protocols for assessing myocardial sarcoidosis.
• Integrate PET/CT findings with clinical and histopathological data to avoid misdiagnosis.