Answer to Photo Quiz: Garland triad identified with HRCT

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DIAGNOSIS

Lofgren syndrome is described as a combination of erythema nodosum (EN), hilar adenopathy, migratory polyarthralgia and fever, and is seen primarily in women. HRCT of the chest revealed a combination of right paratracheal nodes (figure 1, orange arrow), right hilar nodes (figure 1, yellow arrow) and left hilar nodes (figure 1, green arrow) which is exactly like the garland triad seen on the chest X-ray. Garland triad, also known as the 1-2-3 sign or Pawnbrokers sign is a pattern typical, but not specific, of sarcoidosis and identified by chest X-ray.^1,2 As intrathoracic adenopathy is better visualised on HRCT than conventional radiograph, a garland triad can be better identified with HRCT, hence reducing the number of false negative reports.


REFERENCES

1. Theros EG. RPC of the month from the AFIP. Radiology. 1969;92:1557-61. 
2. MarlowTJ, Krapiva PI, Schabel SI, Judson MA. The “fairy ring”: A new radiographic finding in sarcoidosis. Chest. 1999;115:275-6.