Sarcoidosis - stage 1

Case contributed by Kumar V M Ramavathu


Recurrent chest infections needing antibiotics for the last 6 months. Known asthmatic.

Patient Data

Age: 40 years
Gender: Female

Plain radiograph of the chest shows widening of the lower right paratracheal stripe and prominent hilar shadows, suggestive of mediastinal and hilar lymphadenopathy. This appearance has been described as 'Garland traid' or '1-2-3 sign'


CT scan confirms multiple lymph nodes along the mediastinum and both hilar regions, these are discrete and hypodense in attenuation. No calcifications or necrosis within the lymph nodes. The lungs are clear. 

Case Discussion

Sarcoidosis is a granuomatous multisystem disorder and thoracic manifestations are extremely common, seen in over 90% of the affected patients. Thoracic sarcoidosis is staged based on the chest radiograph findings and stage 1 is characterized by mediastinal and hilar lymphadenopath only with absence of lung involvement. Our case shows classical stage 1 features with no pulmonary infiltrates. 

Patient's ACE levels were marginally elevated at 55nmol/mL/min (normal 8-52). The lymph nodes were targeted with Endobronchial Ultrasound (EBUS) and cytology revealed non-caseating epthelioid granuloma and scattered giant cells in a background of lymphoid cells, consistent with sarcoidosis. 

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