Sarcoidosis

Case contributed by Dr Henry Knipe

Presentation

Cough for six months. No fevers.

Patient Data

Age: 45 years
Gender: Male
X-ray

Right hilar mass and multiple bilateral lung nodules are identified. Cardiac silhouette is not enlarged.

CT

High resolution

Bilateral pulmonary nodules without cavitation or calcification. Scattered randomly throughout both lungs. Enlarged pretracheal lymph and right hilar nodes. No evidence of interstitial disease. 

After a negative EBUS the patient proceeded to a CT guided pulmonary nodule biopsy. 

HISTOPATHOLOGY

MICROSCOPIC DESCRIPTION: Sections show non-necrotising granulomatous inflammation in a background of dense fibrous tissue. No normal lung parenchyma is identified. The adjacent bronchial epithelium appears intact. ZN, Fite, PAS and Grocott stains are negative. There is no evidence of dysplasia or malignancy.

DIAGNOSIS:

Lung core biopsy: Non-necrotising granulomatous inflammation. Features favouring sarcoidosis.

Case Discussion

The differential diagnosis for random pulmonary nodules includes:

  • nodular pulmonary metastases
  • infection, e.g. tuberculosis
  • sarcoidosis
  • silicosis
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Case information

rID: 43131
Published: 25th Feb 2016
Last edited: 16th Jul 2018
System: Chest
Tag: hrct
Inclusion in quiz mode: Included

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