Medical Image of the Week: Sarcoidosis

Figure 1.  Stage 2 radiographic sarcoidosis with lymphadenopathy (arrows) on CXR (A), micronodular and macronodular infiltrates with beading along the fissure and bronchovascular bundles are more easily seen  on CT (B), multiple lung granulomas of various sizes and stages of maturity on transbronchial biopsy (C).

A 42 year old African-American man from Indianapolis presented with cough and skin lesions.  ACE level was elevated at 86 μg/L.  Spirometry was normal except for a diffusing capacity 52% of predicted.  Imaging was suggestive of sarcoidosis versus granulomatous infection.  Bronchoscopy with bronchoalveolar lavage cytospin revealed a lymphocytic alveolitis (27% lymphocytes) with a CD4:CD8 ratio of 6.2:1 by flow cytometry.  Biopsy showed classic noncaseating granulomas and no organisms supporting the diagnosis of sarcoidosis.  The patient’s symptoms and radiographic findings improved with 20 mg prednisone every other day for 3 months duration.

Kenneth S. Knox, MD

Division of Pulmonary and Critical Care Medicine

Arizona Respiratory Center

University of Arizona

Tucson, Arizona

Reference as: Knox KS. Medical image of the week: sarcoidosis. Southwest J Pulm Crit Care 2013;6(2):84. PDF