Pulmonary sarcoid

Case contributed by Dr James Harvey

Presentation

Long-standing shortness of breath.

Patient Data

Age: 60 years
Gender: Male
X-ray

Chest

There are bilateral reticulonodular opacities within the mid-zones. Multiple small pulmonary nodules are evident. No airspace opacification.

CT

Chest

Multiple enlarged hilar and mediastinal lymph nodes are stable in size, with partial rim
calcification of the symmetric hilar lymphadenopathy. No axillary or supraclavicular lymphadenopathy.

There are multiple perilymphatic micronodules predominately affecting the bilateral mid zones. Larger nodules with irregular margins within the upper zones and
the subpleural right lower lung base are also stable.  Nodular interlobular thickening is
evident throughout.

There is no ground-glass opacification or consolidation. No traction
bronchiectasis or features of air trapping.  

No pleural effusion or pleural thickening identified.

Small hiatus hernia.

Case Discussion

The lung is the most commonly affected organ in sarcoidosis. Mediastinal lymph nodes (classically with eggshell calcification) are seen in 60-90% of cases. The 1-2-3 pattern of bilateral hilar and right paratracheal lymph node enlargement may be seen.

Nodules are perilymphatic with an upper lobe predominance.
Upper zone fibrosis and traction bronchiectasis occur late in the condition.

This patient underwent a bronchoscopy and biopsy which was non-diagnostic.

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Case information

rID: 70938
Published: 21st Jul 2020
Last edited: 22nd Jul 2020
System: Chest
Inclusion in quiz mode: Included

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