Review Question - QID 100945

The clinical presentation is consistent with sarcoidosis. Enlarged hilar lymph nodes are commonly seen on chest radiographs of patients with sarcoidosis.

Sarcoidosis is a syndrome involving granuloma formation in multiple organs, namely the lungs, liver, spleen, and bones. It is most commonly found in African American females and results in symptoms such as uveitis, cough, and arthralgias. Spirometry findings in these patients are consistent with restriction, though total lung capacity would need to be reduced to confirm restriction. Spirometry in sarcoidosis can also show obstruction or a mixed pattern.

Park et al. review the common radiographic findings of sarcoidosis. They find that common radiologic findings include symmetric, bilateral hilar and paratracheal lymphadenopathy with or without accompanying parenchymal abnormalities such as small nodules. In 25% to 30% of cases, the radiological findings are atypical and unfamiliar to most radiologists, which leads to difficulties in consistently making a correct diagnosis.

Wu et al. review the clinical presentation, evaluation, and treatment of sarcoidosis. Diagnosis is based on clinical and imaging findings, histologic evidence of non-caseating epithelioid granulomas, and exclusion of other granulomatous diseases. Prognosis depends on mode of onset, severity of disease, and host factors. Steroids remain the optimal treatment but dosage and route of administration depend on the involved organs and severity. It is unknown if current treatment methods change the overall course of the disease.

Illustration A is a chest x-ray of a patient with sarcoidosis demonstrating the typical enlarged "potato nodes."

Incorrect Answers:
Answers 2: Kerley B lines are a sign of interstitial pulmonary edema.
Answer 3: Bilateral diaphragmatic elevation can be seen in obesity (low lung volumes from increased intra-abdominal girth and workload) or neuromuscular disease as well as other conditions would be likely show restriction of spirometry, however it would not be expected in sarcoidosis.
Answer 4: Although pleural effusion resulting in fluid in the alveolar walls is a rare complication of sarcoidosis, it is much less common than enlarged hilar lymph nodes.
Answer 5: Fluid in the alveolar walls typical of pulmonary edema is not commonly found in sarcoidosis. Rather, sarcoidosis can cause pulmonary arterial hypertension, which can result in right heart failure and peripheral edema.