Neuromuscular ultrasound with superb microvascular imaging in muscular sarcoidosis: morphological features and treatment monitoring

Muscular sarcoidosis is a rare disease characterised by non-caseating granulomas in muscle tissue. We report a woman in her late 70s with progressive lower-limb weakness, in whom ultrasonography revealed distinctive hypoechoic tumours in muscles. Using superb microvascular imaging (SMI), we detected intricate vascular networks within these lesions, which had not been previously reported in muscular sarcoidosis. Based on the clinical presentation and overall sonographic findings, muscular sarcoidosis was suspected, and a subsequent muscle biopsy provided findings consistent with this diagnosis. After steroid therapy, clinical improvement corresponded with decreased tumour size and reduced vascularity on follow-up ultrasonography. Ultrasonography enhanced by SMI may offer a valuable approach for both detecting muscular sarcoidosis and non-invasively monitoring its therapeutic response.