Sarcoidosis

Case contributed by Dr Davina Bates

Presentation

Worsening shortness of breath

Patient Data

Age: 45 years
Gender: Male
X-ray

Bilateral mid zone opacities with architectural distortion. Bilateral mid zone predominant nodular opacities. 

The pleural spaces are clear.

Normal heart size and cardiomediastinal contour. Subtle calcified lymphadenopathy projected over the aortic knuckle. 

CT

Mid zone predominant confluent opacities and well-defined perilymphatic (peribronchovascular and pleural) nodules. Right middle lobe collapse. 

Mediastinal and bilateral hilar calcified lymphadenopathy. 

No dilation of the main pulmonary trunk. 

5 years later with interval immunosuppression

CT

Reduction in the confluent mid zone opacities and nodules, with residual bands of scarring. 

Persistent right middle lobe collapse. 

Stable calcified mediastinal and hilar lymphadenopathy. 

Case Discussion

The differential in this case is silicosis, however this patient did not have an appropriate exposure history. ACE levels were elevated and the diagnosis of sarcoidosis was confirmed on mediastinal lymph node biopsy. 

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