Weekly Chest CasesArchive of Old Cases

Case No : 470 Date 2006-10-30

  • Courtesy of Yo Won Choi, MD. / Hanyang University Hospital, Korea
  • Age/Sex 37 / M
  • Chief ComplaintCough, sputum, dyspnea for one month 40 pack year smoking No previous history of admission or treatment before the symptom
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Diagnosis With Brief Discussion

Diagnosis
Sarcoidosis
Radiologic Findings
Initial chest radiography shows heterogeneous increased opacities in both lungs. Multiple cystic lesions are noted on the left lung. Axial CT scans obtained a day after chest radiography show diffuse ground glass opacities predominantly in the right upper lung area. Diffuse fine nodules are noted along the bronchovascular bundle and pleura. Multiple cystic lesions are noted in the left lung along with atelectasis of the left lower lobe.

Lung lesions were highly suggestive of sarcoidosis. However, multiple lung cysts in the left side are unsual for sarcoidosis because those caused by sarcoidosis usually abut areas of fibrotic masses and these cysts probably represent paracicatricial emphysema (AJR 2000;174:1751?757). So the cystic lung lesions were considered incidental and unassociated with the right lung lesions. Biopsy of small supraclavicular lymph nodes was formed under the impression of sarcoidosis and showed noncaseating granulomas characteristic of sarcoidosis. Further studies revealed elevated angiotensin converting enzyme and negative results for PPD skin test, supporting the diagnosis of sarcoidosis.

Administration of steroid medication was followed by immediate improvement of symptoms and radiographic features. However, chest radiography obtained 3 months later showed persistent cystic lesions in the left lung.
Brief Review
References
Please refer to
Case 129
Keywords
Lung, Connective tissue diseases, Sarcoidosis ,

No. of Applicants : 46

▶ Correct Answer : 2/46,  4.3%
  • - SSG Hospital & Medical Collge, Vadodara, Gujarat, India MAHAVIR SWAMI
  • - China Medical University Hospital,Taiwan Jun-Jun Yeh
▶ Correct Answer as Differential Diagnosis : 7/46,  15.2%
  • - Radiologie Guiton, La Rochelle, France Denis Chabassiere
  • - ASSC, Safwa, Saudi Arabia Kalari Adinarayana
  • - Hospital Sotiria, Athens, Greece Tzilas Vasilios
  • - Annemasse, Polyclinique de Savoie, France Gay-Dpassier Philippe
  • - Radiologie Guiton, La Rocelle, France Jean-Luc Bigot
  • - Pgimer, Chandigarh, India Ram Prakash Galwa
  • - Mubarak Al Kabeer, Kuwait Varghese Sajeev PJ
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