Sarcoidosis

Case contributed by Dr Ahmed A. Khawwam

Presentation

Patient was referred for assessing fatty liver diagnosed 10 years ago.

Patient Data

Age: 45 years
Gender: Male
CT

The spleen is normal in size but studded with hypodense nodules.

Multiple subcutaneous nodules also noticed.

The visualized part of chest shows bilateral enlarged hilar lymph nodes.

Left side hydrocele with bilateral small enhancing testicular nodules noticed.

Normal attenuation of liver, no fatty changes.

Based on these findings the diagnosis of Sarcoidosis was raised, full chest CT scan was requested.

CT

Multiple bilateral pulmonary nodules in perilymphatic distribution involving interlobular septa and pulmonary fissures.

Enlarged bilateral hilar and mediastinal lymph nodes.

Case Discussion

The striking feature is the abnormal looking spleen, it is studded with small hypodense nodules. This finding lead to start the search for other mentioned findings in the case. Assessment of ACE serum level was recommended, the result came back with significantly elevated levels of ACE along with elevated serum calcium level. The diagnosis of sarcoidosis was made based on imaging findings and blood tests, the patient started course of systemic corticosteroids.

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