Presentation
Worsening shortness of breath
Patient Data
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.
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 yr later with interval immunosuppression
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.