Presentation
Sudden dyspnea and chest pain. Non-smoking.
Patient Data
Large right pneumothorax.
Lung parenchyma changes include multiple centrolobular and peribronchovascular micronodules diffusely distributed, with upper lobe predominance. Interlobular septal thickening is also noticed.
Mediastinal and hilar enlarged lymph nodes with extensive calcifications.
Chest x-ray obtained 17 days after right thoracic drainage and pleurodesis, with significant improvement, showing diffuse reticulonodular pattern with upper lobe predominance and bilateral hilar enlargement (stage II on chest radiograph).
The patient underwent thoracic drainage and pleurodesis, with pneumothorax resolution. Pleural biopsy was performed.
Histology:
Cronic granulomatous inflammation, sarcoid type, with extensive fibrosis. Compatible with sarcoidosis.
Case Discussion
This case shows a possible complication of sarcoidosis affecting the lung and pleura, as well as some typical image findings, such as:
- perilymphatic nodules
- lymphadenopathy: bilateral hilar, paratracheal, aortopulmonary window, subcarinal lymph nodes
- lymph node calcification in chronic disease
- Rupture of subpleural bullae or necrosis of subpleural granulomas are recognized causes of pneumothorax in sarcoidosis, occurring in only 2% of patients. Recurrence is possible, with some authors suggesting this as a manifestation of advanced disease.
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