Case contributed by Oliver Hennessy


Increasing breathlesness over many months

Patient Data

Age: 55
Gender: Female

The radiograph shows a coarse predominantly  reticular infiltrate in both upper lobes. There is associated significant volume loss on both sides.

No definite mediastinal or hilar abnormality is present. Heart size and shape is normal. Both pleural spaces are clear.


The mediastinum demonstrates extensive calcified lymph nodes.

Conventional and HR lung windows show extensive architectural distortion of lung tissue, associated with marked fibrosis, predominantly in both upper zones.

Multiple pulmonary nodules are present in both lungs, many lie in a subpleural and along the fissures Multiple ill defined conglomerate masses are present in addition.

The appearances are in keeping with sarcoidosis.

Case Discussion

The combination of calcified mediastinal nodes, lung fibrosis, nodules in a subpleural and along the fissures makes sarcoidosis the most likely diagnosis in a middle aged woman.

Calcified nodes are also commonly seen in previous TB infection and in people with an history of silica dust exposure .

TB can be associated with upper lobe fibrosis as can silicosis.

Lung nodules are usually present in cases of pneumoconiosis.

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