array:24 [
  "pii" => "S2173574318301588"
  "issn" => "21735743"
  "doi" => "10.1016/j.reumae.2018.11.003"
  "estado" => "S300"
  "fechaPublicacion" => "2019-11-01"
  "aid" => "1110"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
  "copyrightAnyo" => "2017"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Reumatol Clin. 2019;15:e133-e135"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1
    "HTML" => 1
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1699258X17301985"
      "issn" => "1699258X"
      "doi" => "10.1016/j.reuma.2017.07.022"
      "estado" => "S300"
      "fechaPublicacion" => "2019-11-01"
      "aid" => "1110"
      "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Reumatol Clin. 2019;15:e133-e135"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1685
        "formatos" => array:3 [
          "EPUB" => 84
          "HTML" => 1074
          "PDF" => 527
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Caso cl&#237;nico</span>"
        "titulo" => "Sarcoidosis pulmonar simulando una tuberculosis&#58; importancia del signo de la galaxia en TC de t&#243;rax"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "e133"
            "paginaFinal" => "e135"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Pulmonary sarcoidosis mimicking tuberculosis&#58; Importance of the galaxy sign on thoracic computed tomography"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1662
                "Ancho" => 2000
                "Tamanyo" => 331589
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A&#41; Radiograf&#237;a de t&#243;rax en la que se observa una opacidad nodular en LSD &#40;flechas&#41;&#46; B&#41; Imagen axial de la primera TC de t&#243;rax &#40;ventana de par&#233;nquima pulmonar&#41; en la que se confirma una lesi&#243;n nodular de atenuaci&#243;n ground-glass &#40;flecha&#41;&#46; C&#41; Imagen axial MIP &#40;proyecci&#243;n de intensidad m&#225;xima&#41; de la segunda TC de t&#243;rax &#40;ventana de par&#233;nquima pulmonar&#41; en la que se observa una progresi&#243;n radiol&#243;gica a pesar del tratamiento antituberculoso y el signo de la &#171;galaxia&#187;&#58; opacidades nodulares s&#243;lidas &#40;flechas&#41; rodeadas de numerosos n&#243;dulos s&#243;lidos de 1-2<span class="elsevierStyleHsp" style=""></span>mm&#46; D&#41; Imagen coronal de SPECT&#47;TC con galio en la que se identifica captaci&#243;n por parte de los n&#243;dulos pulmonares &#40;flechas blancas&#41; y de las adenopat&#237;as del hilio pulmonar derecho y del mediastino ipsolateral &#40;flechas negras&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Luis Gorospe Saras&#250;a, Almudena Ure&#241;a-Vacas, Paola Arrieta, Astrid Luc&#237;a Santos-Carre&#241;o, Enrique Navas-Elorza, Carlos de la Puente-Bujidos"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "Luis"
                "apellidos" => "Gorospe Saras&#250;a"
              ]
              1 => array:2 [
                "nombre" => "Almudena"
                "apellidos" => "Ure&#241;a-Vacas"
              ]
              2 => array:2 [
                "nombre" => "Paola"
                "apellidos" => "Arrieta"
              ]
              3 => array:2 [
                "nombre" => "Astrid Luc&#237;a"
                "apellidos" => "Santos-Carre&#241;o"
              ]
              4 => array:2 [
                "nombre" => "Enrique"
                "apellidos" => "Navas-Elorza"
              ]
              5 => array:2 [
                "nombre" => "Carlos"
                "apellidos" => "de la Puente-Bujidos"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173574318301588"
          "doi" => "10.1016/j.reumae.2018.11.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301588?idApp=UINPBA00004M"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17301985?idApp=UINPBA00004M"
      "url" => "/1699258X/0000001500000006/v1_201911200727/S1699258X17301985/v1_201911200727/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173574318301436"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2018.10.009"
    "estado" => "S300"
    "fechaPublicacion" => "2019-11-01"
    "aid" => "1087"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2019;15:370-1"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>"
      "titulo" => "Double Cervical Rib&#58; A Case Report"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "370"
          "paginaFinal" => "371"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Doble costilla cervical&#58; a prop&#243;sito de un caso"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1048
              "Ancho" => 900
              "Tamanyo" => 57790
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Proximal cervical rib &#40;thin arrow&#41; originating in vertebral body C3 &#40;star&#41; in a caudal direction and articulating with another distal supernumerary rib &#40;thick arrow&#41; originating and ascending from vertebral body C7 &#40;arrow tip&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Nahia Plaza Aulestia, Sergio Rodr&#237;guez Montero, Mar&#237;a Luisa Velloso Feijoo"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Nahia"
              "apellidos" => "Plaza Aulestia"
            ]
            1 => array:2 [
              "nombre" => "Sergio"
              "apellidos" => "Rodr&#237;guez Montero"
            ]
            2 => array:2 [
              "nombre" => "Mar&#237;a Luisa"
              "apellidos" => "Velloso Feijoo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X17301754"
        "doi" => "10.1016/j.reuma.2017.06.015"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17301754?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301436?idApp=UINPBA00004M"
    "url" => "/21735743/0000001500000006/v1_201911250632/S2173574318301436/v1_201911250632/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S217357431930111X"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2017.07.014"
    "estado" => "S300"
    "fechaPublicacion" => "2019-11-01"
    "aid" => "1112"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "crp"
    "cita" => "Reumatol Clin. 2019;15:e130-e132"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
      "titulo" => "Visceral leishmaniasis in a patient with rheumatoid arthritis treated with methotrexate"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "e130"
          "paginaFinal" => "e132"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Leishmaniasis visceral en un paciente con artritis reumatoide en tratamiento con metotrexato"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 934
              "Ancho" => 800
              "Tamanyo" => 99063
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Bone marrow biopsy&#58; several macrophages can be seen with <span class="elsevierStyleItalic">Leishmania</span> amastigotes in their interior &#40;arrow&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jes&#250;s Loarce-Martos, Sandra Garrote-Corral, Francesca Gioia, Javier Bachiller-Corral"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Jes&#250;s"
              "apellidos" => "Loarce-Martos"
            ]
            1 => array:2 [
              "nombre" => "Sandra"
              "apellidos" => "Garrote-Corral"
            ]
            2 => array:2 [
              "nombre" => "Francesca"
              "apellidos" => "Gioia"
            ]
            3 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Bachiller-Corral"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X17302000"
        "doi" => "10.1016/j.reuma.2017.07.024"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17302000?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431930111X?idApp=UINPBA00004M"
    "url" => "/21735743/0000001500000006/v1_201911250632/S217357431930111X/v1_201911250632/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
    "titulo" => "Pulmonary Sarcoidosis Mimicking Tuberculosis&#58; Importance of the Galaxy Sign on Thoracic Computed Tomography"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "e133"
        "paginaFinal" => "e135"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Luis Gorospe Saras&#250;a, Almudena Ure&#241;a-Vacas, Paola Arrieta, Astrid Luc&#237;a Santos-Carre&#241;o, Enrique Navas-Elorza, Carlos de la Puente-Bujidos"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "Luis"
            "apellidos" => "Gorospe Saras&#250;a"
            "email" => array:1 [
              0 => "luisgorospe@yahoo.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Almudena"
            "apellidos" => "Ure&#241;a-Vacas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Paola"
            "apellidos" => "Arrieta"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Astrid Luc&#237;a"
            "apellidos" => "Santos-Carre&#241;o"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Enrique"
            "apellidos" => "Navas-Elorza"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Carlos"
            "apellidos" => "de la Puente-Bujidos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Servicio de Radiodiagn&#243;stico&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Neumolog&#237;a&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Medicina Nuclear&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Enfermedades Infecciosas&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Reumatolog&#237;a&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Sarcoidosis pulmonar simulando una tuberculosis&#58; importancia del signo de la galaxia en TC de t&#243;rax"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1662
            "Ancho" => 2000
            "Tamanyo" => 331589
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Chest X-ray where a nodular opacity in the URL is observed &#40;arrows&#41;&#46; &#40;B&#41; Axial image of the first chest CT &#40;window of pulmonary parenchyma&#41; in which a nodular lesion of ground-glass attenuation is observed &#40;arrow&#41;&#46; &#40;C&#41; MIP &#40;maximum intensity projection&#41; axial image of the second chest CT &#40;window of pulmonary parenchyma&#41; in which a radiological progression is observed despite antituberculosis treatment and the galaxy sign&#58; solid nodular opacities &#40;arrows&#41; surrounded by multiple solid 1&#8211;2<span class="elsevierStyleHsp" style=""></span>mm nodules&#46; &#40;D&#41; Coronal imaging of SPECT&#47;CT with gallium in which uptake by the pulmonary nodules &#40;white arrows&#41; is determined and by the right pulmonary hilar adenopathies and ipsilateral mediastinum &#40;black arrows&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tuberculosis and sarcoidosis are two common granulomatous chest conditions which share clinical and radiological presentations&#46; As a result they are often diagnostic challenges for clinicians and radiologists&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a> Among the standard radiologic signs of sarcoidosis recently described in chest CT is the sarcoid galaxy sign&#46; This sign consists of a lung nodule formed by the confluence of multiple small-sized nodules which separate from one another as they move away from the centre&#44; and thus portray a similarity to a galaxy of stars&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> We present a case of sarcoidosis which was initially misdiagnosed as tuberculosis and for which the galaxy sign was useful for indicating correct diagnosis within the clinical and radiologic context&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Observation</span><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 42 year-old woman&#44; a non-smoker&#44; of Brazilian origin&#44; who presented with an intermittent cough&#44; for whom a chest X-ray showed nodular opacity in the URL &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; The patient had been studied some months previously by the primary care physician after non cohabitant contact with a case of tuberculosis&#44; and a positive tuberculin test&#46; A chest CT scan confirmed pseudonodular opacity in the URL of ground-glass attenuation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; No enlarged lymph nodes&#44; tree-in-bud opacities or radiological stigmas &#40;calcified granulomas&#44; bronchiectases&#44; calcified adenopathies&#41; were observed from previous tuberculosis&#46; Although the tuberculin test was positive&#44; bronchoalveolar lavage &#40;BAL&#41; and a transbronchial biopsy did not show any microbiological or granuloma changes&#46; Several sputum smears tested negative as well&#46; Despite the absence of microbiological confirmation it was decided the patient was to be treated with 4 antituberculosis drugs&#46; A control chest X-ray four months following treatment initiation showed radiological worsening with the appearance of bilateral parenchymal opacities&#46; However&#44; the patient did not present with new symptoms&#46; A further chest CT scan detected enlarged lymph nodes without necrosis in the right pulmonary hilum and ipsilateral mediastinum&#44; together with various dominant solid pulmonary nodules which characteristically presented with innumerable satellite 1&#8211;2<span class="elsevierStyleHsp" style=""></span>mm nodules around them &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a><span class="elsevierStyleSmallCaps">C</span>&#41;&#46; This radiological presentation is called the galaxy sign&#46; No tree-in-bud images or carious lesions were observed&#46; In view of these findings&#44; stage II pulmonary sarcoidosis was diagnosed&#46; Fine needle aspiration endobronchial ultrasound guided biopsy &#40;EBUS&#41; of the enlarged lymph nodes demonstrated the presence of non-necrotising epithelioid granulomas&#44; confirming the clinical diagnosis of sarcoidosis&#46; No microbacteria were isolated in the BAL&#46; Single-photo emission CT &#40;SPECT&#41; with gallium &#40;67<span class="elsevierStyleHsp" style=""></span>Ga&#41; was combined with CT &#40;SPECT&#47;TC&#41; which showed metabolic uptakes in the dominant pulmonary nodules and in the enlarged lymph nodes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Tuberculosis and sarcoidosis are 2 granulomatous diseases which usually mostly affect the chest and which may present clinical&#44; radiological and even histological similarities&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> This peculiarity means that differential diagnosis between these 2 conditions presents a challenge to clinicians&#44; and particularly in countries where the incidence of tuberculosis is high&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Studies have demonstrated that microbacterial antigens may trigger immunological response and eventually induce sarcoidosis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> However&#44; patients with sarcoidosis treated with corticoids may present with tuberculosis as an infectious complication&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> In our case&#44; a non-cohabitant contact of the patient with a case of tuberculosis &#40;some months earlier&#41;&#44; together with a positive tuberculin test and an X-ray arousing suspicion were &#8220;sufficient&#8221; to justify treatment initiation with antituberculosis drugs&#44; despite the absence of microbiological confirmation in sputum smears and the BAL&#46; The appearance of non-necrotising enlarged lymph nodes in a further chest CT&#44; the absence of standard tuberculosis radiological stigma &#40;calcified adenopathies and granulomas&#44; bronchiectasis&#44; etc&#46;&#41; and above all the galaxy sign indicated that sarcoidosis was responsible for the clinical and radiological symptoms&#46; This suspicion was finally confirmed in the EBUS performed on the patients several weeks later&#46; The galaxy sign was originally described in 2002 in chest CT studies of patients with sarcoidosis &#40;although it is not specific of this entity&#41; and consists of a central dominant pulmonary nodule formed by the confluence of many small-sized nodules&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> These tiny nodules separate from one another as they fade away from the dominant nodule&#44; forming satellite nodules which look like a galaxy of stars&#46; Histologically the galaxy sign represents the coalescence of many interstitial granulomas which form an inseparable large dominant nodule&#46; On the periphery&#44; the granulomas are less concentrated and separate from one another&#44; forming satellite nodules&#46; Although this sign was initially described in patients with sarcoidosis &#40;in fact the term &#8220;sarcoid galaxy&#8221; was coined&#41; it has also been described as being associated with massive progressive fibrosis in patients with silicosis&#44; with some pulmonary tumours and on occasion with active tuberculosis&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> In the immense majority of cases the usefulness of the galaxy sign indicates a benign type of pulmonary tumour&#46; The only exception to this would be that of a peripheral lung adenocarcinoma small in size&#44; although in this case&#44; bilateral and symmetrical adenopathies are not usually found in the mediastinum and the pulmonary hilar structures &#40;as occurs in sarcoidosis&#41;&#44; nor signs of infectious bronchiolitis with necrotic enlarged lymph nodes &#40;as occurs in tuberculosis&#41; nor radiological signs of a complicated type of silicosis&#46; In our specific case it was not just the galaxy sign in isolation&#44; that suggested correct diagnosis of sarcoidosis&#44; but the combination of this radiological finding in a patient with radiological worsening of lung injuries despite having received antituberculosis treatment&#44; together with the appearance of mediastinal adenopathies&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0020" class="elsevierStylePara elsevierViewall">We believe that in some clinical and radiological contexts&#44; and especially if there is radiological progression despite antituberculosis treatment or if there is no microbiological confirmation of microbacteria or radiological stigmas which are typical of tuberculosis&#44; the galaxy sign in chest CT may be highly useful for indicating diagnosis of sarcoidosis&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical Disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of human and animal subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that for this research no experimentation has been carried out on human beings or animals&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have adhered to their centre of work on the publication of patient data&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of Interests</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interests to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1268391"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1173992"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1268392"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1173991"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Clinical Observation"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusions"
        ]
        8 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Ethical Disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        9 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conflict of Interests"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-05-17"
    "fechaAceptado" => "2017-07-19"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1173992"
          "palabras" => array:4 [
            0 => "Sarcoidosis"
            1 => "Tuberculosis"
            2 => "Computed tomography"
            3 => "Galaxy sign"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1173991"
          "palabras" => array:4 [
            0 => "Sarcoidosis"
            1 => "Tuberculosis"
            2 => "Tomograf&#237;a computarizada"
            3 => "Signo de la galaxia"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sarcoidosis and tuberculosis are two common granulomatous conditions that may share clinical and radiological presentations&#46; The galaxy sign &#40;sarcoid galaxy sign&#41; is a characteristic radiological sign of pulmonary sarcoidosis on thoracic computed tomography &#40;CT&#41;&#46; We present the case of a patient with sarcoidosis that was initially misdiagnosed as tuberculosis&#44; in whom the galaxy sign on CT was useful as it suggested the correct diagnosis&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La sarcoidosis y la tuberculosis son 2 enfermedades granulomatosas frecuentes que comparten presentaciones cl&#237;nicas y radiol&#243;gicas&#46; Entre los signos radiol&#243;gicos caracter&#237;sticos de sarcoidosis pulmonar descritos recientemente en la tomograf&#237;a computarizada de t&#243;rax destaca el signo de la &#171;galaxia&#187;&#46; Presentamos un caso de sarcoidosis que inicialmente fue confundido con una tuberculosis en el que este signo radiol&#243;gico fue &#250;til para indicar el diagn&#243;stico correcto&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Gorospe Saras&#250;a L&#44; Ure&#241;a-Vacas A&#44; Arrieta P&#44; Santos-Carre&#241;o AL&#44; Navas-Elorza E&#44; de la Puente-Bujidos C&#46; Sarcoidosis pulmonar simulando una tuberculosis&#58; importancia del signo de la galaxia en TC de t&#243;rax&#46; Reumatol Clin&#46; 2019&#59;15&#58;e133&#8211;e135&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1662
            "Ancho" => 2000
            "Tamanyo" => 331589
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Chest X-ray where a nodular opacity in the URL is observed &#40;arrows&#41;&#46; &#40;B&#41; Axial image of the first chest CT &#40;window of pulmonary parenchyma&#41; in which a nodular lesion of ground-glass attenuation is observed &#40;arrow&#41;&#46; &#40;C&#41; MIP &#40;maximum intensity projection&#41; axial image of the second chest CT &#40;window of pulmonary parenchyma&#41; in which a radiological progression is observed despite antituberculosis treatment and the galaxy sign&#58; solid nodular opacities &#40;arrows&#41; surrounded by multiple solid 1&#8211;2<span class="elsevierStyleHsp" style=""></span>mm nodules&#46; &#40;D&#41; Coronal imaging of SPECT&#47;CT with gallium in which uptake by the pulmonary nodules &#40;white arrows&#41; is determined and by the right pulmonary hilar adenopathies and ipsilateral mediastinum &#40;black arrows&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sarcoidosis and tuberculosis&#58; the same disease with different manifestations or similar manifestations of different disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Gupta"
                            1 => "R&#46; Agarwal"
                            2 => "A&#46;N&#46; Aggarwal"
                            3 => "S&#46;K&#46; Jindal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Curr Opin Pulm Med"
                        "fecha" => "2012"
                        "volumen" => "18"
                        "paginaInicial" => "506"
                        "paginaFinal" => "516"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sarcoidosis&#58; role of non-tuberculosis mycobacteria and Mycobacterium tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Mortaz"
                            1 => "I&#46;M&#46; Adcock"
                            2 => "P&#46;J&#46; Barnes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijmyco.2014.10.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Mycobacteriol"
                        "fecha" => "2014"
                        "volumen" => "3"
                        "paginaInicial" => "225"
                        "paginaFinal" => "229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26786620"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Large coalescent parenchymal nodules in pulmonary sarcoidosis&#58; Sarcoid galaxy sign"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Nakatsu"
                            1 => "H&#46; Hatabu"
                            2 => "K&#46; Morikawa"
                            3 => "H&#46; Uematsu"
                            4 => "Y&#46; Ohno"
                            5 => "K&#46; Nishimura"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2214/ajr.178.6.1781389"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJR Am J Roentgenol"
                        "fecha" => "2002"
                        "volumen" => "178"
                        "paginaInicial" => "1389"
                        "paginaFinal" => "1393"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12034602"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molecular evidence for the role of mycobacteria in sarcoidosis&#58; a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Gupta"
                            1 => "R&#46; Agarwal"
                            2 => "A&#46;N&#46; Aggarwal"
                            3 => "S&#46;K&#46; Jindal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00002607"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2007"
                        "volumen" => "30"
                        "paginaInicial" => "508"
                        "paginaFinal" => "516"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17537780"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The spectrum of opportunistic diseases complicating sarcoidosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Jamilloux"
                            1 => "D&#46; Valeyre"
                            2 => "O&#46; Lortholary"
                            3 => "C&#46; Bernard"
                            4 => "S&#46; Kerever"
                            5 => "L&#46; Lelievre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.autrev.2014.10.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Autoimmun Rev"
                        "fecha" => "2015"
                        "volumen" => "14"
                        "paginaInicial" => "64"
                        "paginaFinal" => "74"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25305373"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Galaxy sign"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Aikins"
                            1 => "J&#46;P&#46; Kanne"
                            2 => "J&#46;H&#46; Chung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/RTI.0b013e31826b7e6f"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thorac Imaging"
                        "fecha" => "2012"
                        "volumen" => "27"
                        "paginaInicial" => "W164"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23059737"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735743/0000001500000006/v1_201911250632/S2173574318301588/v1_201911250632/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "80960"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Cases report"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001500000006/v1_201911250632/S2173574318301588/v1_201911250632/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301588?idApp=UINPBA00004M"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Case Report
Pulmonary Sarcoidosis Mimicking Tuberculosis: Importance of the Galaxy Sign on Thoracic Computed Tomography
Sarcoidosis pulmonar simulando una tuberculosis: importancia del signo de la galaxia en TC de tórax
Luis Gorospe Sarasúaa,
Corresponding author
luisgorospe@yahoo.com

Corresponding author.
, Almudena Ureña-Vacasa, Paola Arrietab, Astrid Lucía Santos-Carreñoc, Enrique Navas-Elorzad, Carlos de la Puente-Bujidose
a Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain
b Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, Spain
c Servicio de Medicina Nuclear, Hospital Universitario Ramón y Cajal, Madrid, Spain
d Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
e Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
Read
7247
Times
was read the article
1674
Total PDF
5573
Total HTML
Share statistics
 array:24 [
  "pii" => "S2173574318301588"
  "issn" => "21735743"
  "doi" => "10.1016/j.reumae.2018.11.003"
  "estado" => "S300"
  "fechaPublicacion" => "2019-11-01"
  "aid" => "1110"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
  "copyrightAnyo" => "2017"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Reumatol Clin. 2019;15:e133-e135"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1
    "HTML" => 1
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1699258X17301985"
      "issn" => "1699258X"
      "doi" => "10.1016/j.reuma.2017.07.022"
      "estado" => "S300"
      "fechaPublicacion" => "2019-11-01"
      "aid" => "1110"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Reumatol Clin. 2019;15:e133-e135"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1685
        "formatos" => array:3 [
          "EPUB" => 84
          "HTML" => 1074
          "PDF" => 527
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Caso cl&#237;nico</span>"
        "titulo" => "Sarcoidosis pulmonar simulando una tuberculosis&#58; importancia del signo de la galaxia en TC de t&#243;rax"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "e133"
            "paginaFinal" => "e135"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Pulmonary sarcoidosis mimicking tuberculosis&#58; Importance of the galaxy sign on thoracic computed tomography"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1662
                "Ancho" => 2000
                "Tamanyo" => 331589
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A&#41; Radiograf&#237;a de t&#243;rax en la que se observa una opacidad nodular en LSD &#40;flechas&#41;&#46; B&#41; Imagen axial de la primera TC de t&#243;rax &#40;ventana de par&#233;nquima pulmonar&#41; en la que se confirma una lesi&#243;n nodular de atenuaci&#243;n ground-glass &#40;flecha&#41;&#46; C&#41; Imagen axial MIP &#40;proyecci&#243;n de intensidad m&#225;xima&#41; de la segunda TC de t&#243;rax &#40;ventana de par&#233;nquima pulmonar&#41; en la que se observa una progresi&#243;n radiol&#243;gica a pesar del tratamiento antituberculoso y el signo de la &#171;galaxia&#187;&#58; opacidades nodulares s&#243;lidas &#40;flechas&#41; rodeadas de numerosos n&#243;dulos s&#243;lidos de 1-2<span class="elsevierStyleHsp" style=""></span>mm&#46; D&#41; Imagen coronal de SPECT&#47;TC con galio en la que se identifica captaci&#243;n por parte de los n&#243;dulos pulmonares &#40;flechas blancas&#41; y de las adenopat&#237;as del hilio pulmonar derecho y del mediastino ipsolateral &#40;flechas negras&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Luis Gorospe Saras&#250;a, Almudena Ure&#241;a-Vacas, Paola Arrieta, Astrid Luc&#237;a Santos-Carre&#241;o, Enrique Navas-Elorza, Carlos de la Puente-Bujidos"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "Luis"
                "apellidos" => "Gorospe Saras&#250;a"
              ]
              1 => array:2 [
                "nombre" => "Almudena"
                "apellidos" => "Ure&#241;a-Vacas"
              ]
              2 => array:2 [
                "nombre" => "Paola"
                "apellidos" => "Arrieta"
              ]
              3 => array:2 [
                "nombre" => "Astrid Luc&#237;a"
                "apellidos" => "Santos-Carre&#241;o"
              ]
              4 => array:2 [
                "nombre" => "Enrique"
                "apellidos" => "Navas-Elorza"
              ]
              5 => array:2 [
                "nombre" => "Carlos"
                "apellidos" => "de la Puente-Bujidos"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173574318301588"
          "doi" => "10.1016/j.reumae.2018.11.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301588?idApp=UINPBA00004M"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17301985?idApp=UINPBA00004M"
      "url" => "/1699258X/0000001500000006/v1_201911200727/S1699258X17301985/v1_201911200727/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173574318301436"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2018.10.009"
    "estado" => "S300"
    "fechaPublicacion" => "2019-11-01"
    "aid" => "1087"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2019;15:370-1"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>"
      "titulo" => "Double Cervical Rib&#58; A Case Report"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "370"
          "paginaFinal" => "371"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Doble costilla cervical&#58; a prop&#243;sito de un caso"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1048
              "Ancho" => 900
              "Tamanyo" => 57790
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Proximal cervical rib &#40;thin arrow&#41; originating in vertebral body C3 &#40;star&#41; in a caudal direction and articulating with another distal supernumerary rib &#40;thick arrow&#41; originating and ascending from vertebral body C7 &#40;arrow tip&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Nahia Plaza Aulestia, Sergio Rodr&#237;guez Montero, Mar&#237;a Luisa Velloso Feijoo"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Nahia"
              "apellidos" => "Plaza Aulestia"
            ]
            1 => array:2 [
              "nombre" => "Sergio"
              "apellidos" => "Rodr&#237;guez Montero"
            ]
            2 => array:2 [
              "nombre" => "Mar&#237;a Luisa"
              "apellidos" => "Velloso Feijoo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X17301754"
        "doi" => "10.1016/j.reuma.2017.06.015"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17301754?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301436?idApp=UINPBA00004M"
    "url" => "/21735743/0000001500000006/v1_201911250632/S2173574318301436/v1_201911250632/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S217357431930111X"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2017.07.014"
    "estado" => "S300"
    "fechaPublicacion" => "2019-11-01"
    "aid" => "1112"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "crp"
    "cita" => "Reumatol Clin. 2019;15:e130-e132"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
      "titulo" => "Visceral leishmaniasis in a patient with rheumatoid arthritis treated with methotrexate"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "e130"
          "paginaFinal" => "e132"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Leishmaniasis visceral en un paciente con artritis reumatoide en tratamiento con metotrexato"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 934
              "Ancho" => 800
              "Tamanyo" => 99063
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Bone marrow biopsy&#58; several macrophages can be seen with <span class="elsevierStyleItalic">Leishmania</span> amastigotes in their interior &#40;arrow&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jes&#250;s Loarce-Martos, Sandra Garrote-Corral, Francesca Gioia, Javier Bachiller-Corral"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Jes&#250;s"
              "apellidos" => "Loarce-Martos"
            ]
            1 => array:2 [
              "nombre" => "Sandra"
              "apellidos" => "Garrote-Corral"
            ]
            2 => array:2 [
              "nombre" => "Francesca"
              "apellidos" => "Gioia"
            ]
            3 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Bachiller-Corral"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X17302000"
        "doi" => "10.1016/j.reuma.2017.07.024"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17302000?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431930111X?idApp=UINPBA00004M"
    "url" => "/21735743/0000001500000006/v1_201911250632/S217357431930111X/v1_201911250632/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
    "titulo" => "Pulmonary Sarcoidosis Mimicking Tuberculosis&#58; Importance of the Galaxy Sign on Thoracic Computed Tomography"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "e133"
        "paginaFinal" => "e135"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Luis Gorospe Saras&#250;a, Almudena Ure&#241;a-Vacas, Paola Arrieta, Astrid Luc&#237;a Santos-Carre&#241;o, Enrique Navas-Elorza, Carlos de la Puente-Bujidos"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "Luis"
            "apellidos" => "Gorospe Saras&#250;a"
            "email" => array:1 [
              0 => "luisgorospe@yahoo.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Almudena"
            "apellidos" => "Ure&#241;a-Vacas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Paola"
            "apellidos" => "Arrieta"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Astrid Luc&#237;a"
            "apellidos" => "Santos-Carre&#241;o"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Enrique"
            "apellidos" => "Navas-Elorza"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Carlos"
            "apellidos" => "de la Puente-Bujidos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Servicio de Radiodiagn&#243;stico&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Neumolog&#237;a&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Medicina Nuclear&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Enfermedades Infecciosas&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Reumatolog&#237;a&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Sarcoidosis pulmonar simulando una tuberculosis&#58; importancia del signo de la galaxia en TC de t&#243;rax"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1662
            "Ancho" => 2000
            "Tamanyo" => 331589
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Chest X-ray where a nodular opacity in the URL is observed &#40;arrows&#41;&#46; &#40;B&#41; Axial image of the first chest CT &#40;window of pulmonary parenchyma&#41; in which a nodular lesion of ground-glass attenuation is observed &#40;arrow&#41;&#46; &#40;C&#41; MIP &#40;maximum intensity projection&#41; axial image of the second chest CT &#40;window of pulmonary parenchyma&#41; in which a radiological progression is observed despite antituberculosis treatment and the galaxy sign&#58; solid nodular opacities &#40;arrows&#41; surrounded by multiple solid 1&#8211;2<span class="elsevierStyleHsp" style=""></span>mm nodules&#46; &#40;D&#41; Coronal imaging of SPECT&#47;CT with gallium in which uptake by the pulmonary nodules &#40;white arrows&#41; is determined and by the right pulmonary hilar adenopathies and ipsilateral mediastinum &#40;black arrows&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tuberculosis and sarcoidosis are two common granulomatous chest conditions which share clinical and radiological presentations&#46; As a result they are often diagnostic challenges for clinicians and radiologists&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a> Among the standard radiologic signs of sarcoidosis recently described in chest CT is the sarcoid galaxy sign&#46; This sign consists of a lung nodule formed by the confluence of multiple small-sized nodules which separate from one another as they move away from the centre&#44; and thus portray a similarity to a galaxy of stars&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> We present a case of sarcoidosis which was initially misdiagnosed as tuberculosis and for which the galaxy sign was useful for indicating correct diagnosis within the clinical and radiologic context&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Observation</span><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 42 year-old woman&#44; a non-smoker&#44; of Brazilian origin&#44; who presented with an intermittent cough&#44; for whom a chest X-ray showed nodular opacity in the URL &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; The patient had been studied some months previously by the primary care physician after non cohabitant contact with a case of tuberculosis&#44; and a positive tuberculin test&#46; A chest CT scan confirmed pseudonodular opacity in the URL of ground-glass attenuation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; No enlarged lymph nodes&#44; tree-in-bud opacities or radiological stigmas &#40;calcified granulomas&#44; bronchiectases&#44; calcified adenopathies&#41; were observed from previous tuberculosis&#46; Although the tuberculin test was positive&#44; bronchoalveolar lavage &#40;BAL&#41; and a transbronchial biopsy did not show any microbiological or granuloma changes&#46; Several sputum smears tested negative as well&#46; Despite the absence of microbiological confirmation it was decided the patient was to be treated with 4 antituberculosis drugs&#46; A control chest X-ray four months following treatment initiation showed radiological worsening with the appearance of bilateral parenchymal opacities&#46; However&#44; the patient did not present with new symptoms&#46; A further chest CT scan detected enlarged lymph nodes without necrosis in the right pulmonary hilum and ipsilateral mediastinum&#44; together with various dominant solid pulmonary nodules which characteristically presented with innumerable satellite 1&#8211;2<span class="elsevierStyleHsp" style=""></span>mm nodules around them &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a><span class="elsevierStyleSmallCaps">C</span>&#41;&#46; This radiological presentation is called the galaxy sign&#46; No tree-in-bud images or carious lesions were observed&#46; In view of these findings&#44; stage II pulmonary sarcoidosis was diagnosed&#46; Fine needle aspiration endobronchial ultrasound guided biopsy &#40;EBUS&#41; of the enlarged lymph nodes demonstrated the presence of non-necrotising epithelioid granulomas&#44; confirming the clinical diagnosis of sarcoidosis&#46; No microbacteria were isolated in the BAL&#46; Single-photo emission CT &#40;SPECT&#41; with gallium &#40;67<span class="elsevierStyleHsp" style=""></span>Ga&#41; was combined with CT &#40;SPECT&#47;TC&#41; which showed metabolic uptakes in the dominant pulmonary nodules and in the enlarged lymph nodes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Tuberculosis and sarcoidosis are 2 granulomatous diseases which usually mostly affect the chest and which may present clinical&#44; radiological and even histological similarities&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> This peculiarity means that differential diagnosis between these 2 conditions presents a challenge to clinicians&#44; and particularly in countries where the incidence of tuberculosis is high&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Studies have demonstrated that microbacterial antigens may trigger immunological response and eventually induce sarcoidosis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> However&#44; patients with sarcoidosis treated with corticoids may present with tuberculosis as an infectious complication&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> In our case&#44; a non-cohabitant contact of the patient with a case of tuberculosis &#40;some months earlier&#41;&#44; together with a positive tuberculin test and an X-ray arousing suspicion were &#8220;sufficient&#8221; to justify treatment initiation with antituberculosis drugs&#44; despite the absence of microbiological confirmation in sputum smears and the BAL&#46; The appearance of non-necrotising enlarged lymph nodes in a further chest CT&#44; the absence of standard tuberculosis radiological stigma &#40;calcified adenopathies and granulomas&#44; bronchiectasis&#44; etc&#46;&#41; and above all the galaxy sign indicated that sarcoidosis was responsible for the clinical and radiological symptoms&#46; This suspicion was finally confirmed in the EBUS performed on the patients several weeks later&#46; The galaxy sign was originally described in 2002 in chest CT studies of patients with sarcoidosis &#40;although it is not specific of this entity&#41; and consists of a central dominant pulmonary nodule formed by the confluence of many small-sized nodules&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> These tiny nodules separate from one another as they fade away from the dominant nodule&#44; forming satellite nodules which look like a galaxy of stars&#46; Histologically the galaxy sign represents the coalescence of many interstitial granulomas which form an inseparable large dominant nodule&#46; On the periphery&#44; the granulomas are less concentrated and separate from one another&#44; forming satellite nodules&#46; Although this sign was initially described in patients with sarcoidosis &#40;in fact the term &#8220;sarcoid galaxy&#8221; was coined&#41; it has also been described as being associated with massive progressive fibrosis in patients with silicosis&#44; with some pulmonary tumours and on occasion with active tuberculosis&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> In the immense majority of cases the usefulness of the galaxy sign indicates a benign type of pulmonary tumour&#46; The only exception to this would be that of a peripheral lung adenocarcinoma small in size&#44; although in this case&#44; bilateral and symmetrical adenopathies are not usually found in the mediastinum and the pulmonary hilar structures &#40;as occurs in sarcoidosis&#41;&#44; nor signs of infectious bronchiolitis with necrotic enlarged lymph nodes &#40;as occurs in tuberculosis&#41; nor radiological signs of a complicated type of silicosis&#46; In our specific case it was not just the galaxy sign in isolation&#44; that suggested correct diagnosis of sarcoidosis&#44; but the combination of this radiological finding in a patient with radiological worsening of lung injuries despite having received antituberculosis treatment&#44; together with the appearance of mediastinal adenopathies&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0020" class="elsevierStylePara elsevierViewall">We believe that in some clinical and radiological contexts&#44; and especially if there is radiological progression despite antituberculosis treatment or if there is no microbiological confirmation of microbacteria or radiological stigmas which are typical of tuberculosis&#44; the galaxy sign in chest CT may be highly useful for indicating diagnosis of sarcoidosis&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical Disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of human and animal subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that for this research no experimentation has been carried out on human beings or animals&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have adhered to their centre of work on the publication of patient data&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of Interests</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interests to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1268391"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1173992"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1268392"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1173991"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Clinical Observation"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusions"
        ]
        8 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Ethical Disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        9 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conflict of Interests"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-05-17"
    "fechaAceptado" => "2017-07-19"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1173992"
          "palabras" => array:4 [
            0 => "Sarcoidosis"
            1 => "Tuberculosis"
            2 => "Computed tomography"
            3 => "Galaxy sign"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1173991"
          "palabras" => array:4 [
            0 => "Sarcoidosis"
            1 => "Tuberculosis"
            2 => "Tomograf&#237;a computarizada"
            3 => "Signo de la galaxia"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sarcoidosis and tuberculosis are two common granulomatous conditions that may share clinical and radiological presentations&#46; The galaxy sign &#40;sarcoid galaxy sign&#41; is a characteristic radiological sign of pulmonary sarcoidosis on thoracic computed tomography &#40;CT&#41;&#46; We present the case of a patient with sarcoidosis that was initially misdiagnosed as tuberculosis&#44; in whom the galaxy sign on CT was useful as it suggested the correct diagnosis&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La sarcoidosis y la tuberculosis son 2 enfermedades granulomatosas frecuentes que comparten presentaciones cl&#237;nicas y radiol&#243;gicas&#46; Entre los signos radiol&#243;gicos caracter&#237;sticos de sarcoidosis pulmonar descritos recientemente en la tomograf&#237;a computarizada de t&#243;rax destaca el signo de la &#171;galaxia&#187;&#46; Presentamos un caso de sarcoidosis que inicialmente fue confundido con una tuberculosis en el que este signo radiol&#243;gico fue &#250;til para indicar el diagn&#243;stico correcto&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Gorospe Saras&#250;a L&#44; Ure&#241;a-Vacas A&#44; Arrieta P&#44; Santos-Carre&#241;o AL&#44; Navas-Elorza E&#44; de la Puente-Bujidos C&#46; Sarcoidosis pulmonar simulando una tuberculosis&#58; importancia del signo de la galaxia en TC de t&#243;rax&#46; Reumatol Clin&#46; 2019&#59;15&#58;e133&#8211;e135&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1662
            "Ancho" => 2000
            "Tamanyo" => 331589
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Chest X-ray where a nodular opacity in the URL is observed &#40;arrows&#41;&#46; &#40;B&#41; Axial image of the first chest CT &#40;window of pulmonary parenchyma&#41; in which a nodular lesion of ground-glass attenuation is observed &#40;arrow&#41;&#46; &#40;C&#41; MIP &#40;maximum intensity projection&#41; axial image of the second chest CT &#40;window of pulmonary parenchyma&#41; in which a radiological progression is observed despite antituberculosis treatment and the galaxy sign&#58; solid nodular opacities &#40;arrows&#41; surrounded by multiple solid 1&#8211;2<span class="elsevierStyleHsp" style=""></span>mm nodules&#46; &#40;D&#41; Coronal imaging of SPECT&#47;CT with gallium in which uptake by the pulmonary nodules &#40;white arrows&#41; is determined and by the right pulmonary hilar adenopathies and ipsilateral mediastinum &#40;black arrows&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sarcoidosis and tuberculosis&#58; the same disease with different manifestations or similar manifestations of different disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Gupta"
                            1 => "R&#46; Agarwal"
                            2 => "A&#46;N&#46; Aggarwal"
                            3 => "S&#46;K&#46; Jindal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Curr Opin Pulm Med"
                        "fecha" => "2012"
                        "volumen" => "18"
                        "paginaInicial" => "506"
                        "paginaFinal" => "516"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sarcoidosis&#58; role of non-tuberculosis mycobacteria and Mycobacterium tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Mortaz"
                            1 => "I&#46;M&#46; Adcock"
                            2 => "P&#46;J&#46; Barnes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijmyco.2014.10.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Mycobacteriol"
                        "fecha" => "2014"
                        "volumen" => "3"
                        "paginaInicial" => "225"
                        "paginaFinal" => "229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26786620"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Large coalescent parenchymal nodules in pulmonary sarcoidosis&#58; Sarcoid galaxy sign"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Nakatsu"
                            1 => "H&#46; Hatabu"
                            2 => "K&#46; Morikawa"
                            3 => "H&#46; Uematsu"
                            4 => "Y&#46; Ohno"
                            5 => "K&#46; Nishimura"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2214/ajr.178.6.1781389"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJR Am J Roentgenol"
                        "fecha" => "2002"
                        "volumen" => "178"
                        "paginaInicial" => "1389"
                        "paginaFinal" => "1393"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12034602"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molecular evidence for the role of mycobacteria in sarcoidosis&#58; a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Gupta"
                            1 => "R&#46; Agarwal"
                            2 => "A&#46;N&#46; Aggarwal"
                            3 => "S&#46;K&#46; Jindal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00002607"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2007"
                        "volumen" => "30"
                        "paginaInicial" => "508"
                        "paginaFinal" => "516"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17537780"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The spectrum of opportunistic diseases complicating sarcoidosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Jamilloux"
                            1 => "D&#46; Valeyre"
                            2 => "O&#46; Lortholary"
                            3 => "C&#46; Bernard"
                            4 => "S&#46; Kerever"
                            5 => "L&#46; Lelievre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.autrev.2014.10.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Autoimmun Rev"
                        "fecha" => "2015"
                        "volumen" => "14"
                        "paginaInicial" => "64"
                        "paginaFinal" => "74"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25305373"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Galaxy sign"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Aikins"
                            1 => "J&#46;P&#46; Kanne"
                            2 => "J&#46;H&#46; Chung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/RTI.0b013e31826b7e6f"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thorac Imaging"
                        "fecha" => "2012"
                        "volumen" => "27"
                        "paginaInicial" => "W164"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23059737"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735743/0000001500000006/v1_201911250632/S2173574318301588/v1_201911250632/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "80960"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Cases report"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001500000006/v1_201911250632/S2173574318301588/v1_201911250632/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301588?idApp=UINPBA00004M"
]
Article information
ISSN: 21735743
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 October 47 13 60
2024 September 162 25 187
2024 August 140 48 188
2024 July 124 35 159
2024 June 142 36 178
2024 May 172 39 211
2024 April 172 39 211
2024 March 119 27 146
2024 February 146 28 174
2024 January 140 23 163
2023 December 131 25 156
2023 November 148 24 172
2023 October 179 23 202
2023 September 152 42 194
2023 August 133 24 157
2023 July 122 25 147
2023 June 134 27 161
2023 May 111 24 135
2023 April 87 9 96
2023 March 133 33 166
2023 February 101 27 128
2023 January 122 25 147
2022 December 110 27 137
2022 November 101 34 135
2022 October 121 28 149
2022 September 108 31 139
2022 August 118 46 164
2022 July 94 40 134
2022 June 71 31 102
2022 May 82 45 127
2022 April 119 41 160
2022 March 130 48 178
2022 February 161 30 191
2022 January 108 45 153
2021 December 82 45 127
2021 November 64 55 119
2021 October 120 41 161
2021 September 63 39 102
2021 August 58 35 93
2021 July 76 21 97
2021 June 126 50 176
2021 May 59 46 105
2021 April 160 69 229
2021 March 83 31 114
2021 February 52 15 67
2021 January 69 18 87
2020 December 36 11 47
2020 November 63 26 89
2020 October 32 23 55
2020 September 43 17 60
2020 August 23 18 41
2020 July 37 17 54
2020 June 50 10 60
2020 May 36 20 56
2020 January 1 0 1
Show all

Follow this link to access the full text of the article

Idiomas
Reumatología Clínica (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?