The lambda sign in gallium 67 Scintigraphy is a useful clue
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A 40 year old man visited with fever, perspiration, fatigue, and joint pain lasting 1 month, with a 5 kg weight loss. He had neither respiratory symptoms nor visual disturbances. His physical examination findings revealed no abnormality other than tenderness in both ankle joints and nodules in both iridocorneal angles.

Chest X rays showed bilateral hilar lymphadenopathy, contrast enhanced thoracic CT revealed hilar lymphadenopathy and enlarged lymph nodes in the mediastinum and at S5 in the right lung field. Gallium 67 scintigraphy showed abnormally high uptake in lymph nodes at bilateral hila and mediastinum, and along bronchovascular bundles, the typical lambda sign. The patient was subsequently diagnosed with systemic sarcoidosis according to the findings of bronchoalveolar lavage & histopathological examinations of transbronchial lung biopsies.

The sign strongly suggests the diagnosis of sarcoidosis because all reported patients with the sign were subsequently diagnosed as having sarcoidosis. Importantly, 33% of patients with no abnormalities on chest X ray were reported to have the sign. Identifying the sign with gallium 67 scintigraphy could be a valuable clue to the early diagnosis of sarcoidosis.

source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.3295?af=R
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