Sarcoidosis

Case contributed by Dr Sally Ayesa

Presentation

Epigastric pain. ?pneumoperitoneum.

Patient Data

Age: 30 years
Gender: Male
X-ray

There is bilateral hilar enlargement with thickening of the right paratracheal stripe. 

The lungs are clear. 

No evidence of pneumoperitoneum. 

CT

CT demonstrates enlarged lymph nodes in bilateral hila, the right paratracheal station and the aorto-pulmonary window. Lymph nodes are rounded and homogenously enhancing. 

The lungs appear normal. No pleural or pericardial effusions. 

Case Discussion

The chest x-ray appearances demonstrate a "Garland Triad" or "1-2-3 sign" which has been described in sarcoidosis, characterized by enlarged right paratracheal and bilateral hila lymph nodes. Lymphadenopathy was confirmed on CT. This patient did not demonstrate any reticulonodular changes in the lungs to indicate pulmonary sarcoidosis. 

EBUS (endobronchial ultrasound) was performed, with lymph node cytology demonstrating granulomas. This confirmed the diagnosis of sarcoidosis (stage I). 

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