Thoracic CT revealed bilateral hilar lymphadenopathy
and the patient was referred to our hospital for further diagnosis and treatment, where she underwent endobronchial ultrasound-assisted lymph node biopsy in our pulmonary diseases unit.
One patient had FIGO IA Endometrial Adenocarcinoma diagnosed a year prior to PET-positive bilateral hilar lymphadenopathy
. PET was remarkable for bilateral hilar uptake, with SUV max in representative left hilar nodes at 6.6, infracarinal node at 6.9, and right hilar node at 6.2.
Caption: FIGURE 4: Reticulonodular infiltrates at the apex of the right lungs associated with bilateral hilar lymphadenopathy
Moderate right pleural effusion with passive atelectasis of the right middle and lower lobes; bilateral hilar lymphadenopathy
; perihepatic ascites.
It is difficult to confirm the diagnosis in patients suspected to have ocular sarcoidosis without biopsy findings or significant extraocular manifestations, such as bilateral hilar lymphadenopathy
, increased serum angiotensin-converting enzyme (ACE) level, and other laboratory findings.
Bilateral hilar lymphadenopathy
, pulmonary infiltration, and skin, eye and locomotor findings are important clinical findings.
Sarcoidosis involves the bronchi or lung in more than 90 percent of patients and intrathoracic manifestations are protean, ranging from asymptomatic bilateral hilar lymphadenopathy
to chronic, progressive, (ultimately fatal), respiratory insufficiency.
It is generally observed in young adults (20-40 years old), and it often presents with bilateral hilar lymphadenopathy
, pulmonary infiltration, and skin and ocular involvement.
X-ray chest (PA) view showed bilateral hilar lymphadenopathy
X-rays showed bilateral hilar lymphadenopathy
, which was consistent with pulmonary sarcoidosis, and the lace-like appearance of the middle and distal phalanges was consistent with skeletal sarcoidosis.
Followup computed tomography (CT) (Figure 2) of the chest with contrast revealed multiple pulmonary nodules with a dominant right middle lobe mass (5x4x3cm), as well as abnormal mediastinal and bilateral hilar lymphadenopathy
, concerning for a neoplastic process.
On chest X-ray examination, bilateral hilar lymphadenopathy
(BHL) is common, as are nodules, which predominantly affect the upper lobes.