Multisystem sarcoidosis

Case contributed by Ian Bickle
Diagnosis certain

Presentation

RIght upper quadrant pain. Elective cholecystectomy. Surprise findings at surgery of a liver capsule peppered with nodules.

Patient Data

Age: 35 years
Gender: Female
ct

Innumerable nodules throughout both lungs, predominantly miliary. The odd nodule measuring up to 5 mm.

Extensive nodularity along the fissural surfaces.

Lymphadenopathy at almost all nodal stations in the mediastinum, the largest 3.3 cm in the subcarinal space and confluent lymph node enlargement at both hila. No lymph node necrosis or calcification.

Several lymph nodes in the right axilla measuring to 1.2 cm.

Multiple small low-attenuation lesions throughout the liver and spleen, the largest 7mm.

The remainder of the solid organs of the upper abdomen are normal in appearance.

Small volume subcentimeter lymph nodes in the epigastrium and small bowel mesentery. Small bilateral external iliac nodes measuring up to 1.2 cm.

No other abnormality in the abdomen and pelvis.

No bony abnormality.

 

4 months earlier

x-ray

Diffuse miliary nodules throughout both lungs with an upper lobe predominance.

Bilateral hilar enlargement and minor widening of the distal right paratracheal space.

Heart size normal.

Case Discussion

The appearances in lungs, liver and spleen are consistent with sarcoidosis.

It was only after a surgical biopsy of the liver capsule at the time of routine cholecystectomy that a CT was requested and this new diagnosis of sarcoidosis was made.

Although largely a disease of the lungs, it is a true multisystem disorder.  Hepatosplenic involvement is uncommon.

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