Presenting complaint of weight loss with elevated GGT and alkaline phosphatase in a male patient without history of alcoholism.

Fractionation of alkaline phosphatase performed. Hepatitis viral serology negative.

Antimitochondrial antibody was negative and so primary biliary cirrhosis less likely.

Liver biopsy and biopsy of mediastinal lymph nodes was performed by gastroenterology which showed non-caseating granulomas in both areas.

Currently he is waiting to be seen by a sarcoid specialist to decide treatment with steroids as this is most likely a non-pulmonary acute manifestation of sarcoidosis.

This case again highlights the role of multiple modalities in making the correct diagnosis despite CT coming out ahead as it is less operator dependent and requires less patient cooperation for breath holding.