Presentation
Smoker, presents with 2 month history of productive cough with no response to antibiotics.
Patient Data
There is a widespread, predominantly reticulonodular pattern with relative sparing of the lung bases. There is widening of the right paratracheal stripe and a bulky left hilum in keeping with underlying lymphadenopathy.
There is extensive bilateral (<3 mm) nodular pulmonary infiltrate with nodularity also present in relation to the fissures. In addition, there is bilateral hilar and paratracheal lymphadenopathy. The subpleural region is involved and there is relative sparing of the bases.
Within the upper abdomen, the whole of the spleen is not completely visualized but measures at least 13 cm, suggesting splenomegaly. Renal cyst and calculi.
Case Discussion
Whilst there is a broad differential of nodular pulmonary infiltrates the combination of bilateral hilar lymphadenopathy and peri-fissural nodules makes sarcoidosis the most likely diagnosis.
The patient went on to have a transbronchial lung biopsy which confirmed the diagnosis.