Presentation
Severe shortness of breath. CT pulmonary angiography was requested to exclude pulmonary embolism. Clinical examination revealed erythema nodosum on the legs.
Patient Data
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Marked mediastinal and bilateral hilar lymphadenopathy at different nodal groups, most of them matted together forming soft tissue masses.
Scattered tiny pulmonary nodules , fine reticulations and congested lung parenchymal vessels.
HISTOPATHOLOGY REPORT:
Section of specimens revealed multiple non-caseating epithelioid granulomas, composed of epithelioid histiocytes and multinucleated giant cells with residual benign lymphoid tissue in between. No acid-fast bacilli were identified by Z-N stain. No malignancy noted.
Diagnosis: Non-caseating granulomas, consistent with sarcoidosis.
Case Discussion
The differential diagnosis includes sarcoidosis, lymphoma and TB.
The appearance and distribution of nodes are suggestive of sarcoidosis and this was confirmed by transbronchial nodal biopsy and histo-pathology assessment.
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