Presentation
Epigastric pain. ?pneumoperitoneum.
Patient Data
There is bilateral hilar enlargement with thickening of the right paratracheal stripe.
The lungs are clear.
No evidence of pneumoperitoneum.
There are enlarged lymph nodes in bilateral hila, the right paratracheal station and the aorto-pulmonary window. Lymph nodes are rounded and homogeneously enhancing.
The lungs are normal. No pleural or pericardial effusions.
Case Discussion
The chest x-ray appearances demonstrate a "Garland triad" or "1-2-3 sign" which has been described in sarcoidosis, characterized by enlarged right paratracheal and bilateral hila lymph nodes. Lymphadenopathy was confirmed on CT. This patient did not demonstrate any reticulonodular changes in the lungs to indicate pulmonary sarcoidosis.
EBUS (endobronchial ultrasound) was performed, with lymph node cytology demonstrating granulomas. This confirmed the diagnosis of sarcoidosis (stage I).
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