Atypical CT findings of pulmonary sarcoidosis A case report

Rationale: Pulmonary involvement occurs in about 90% of patients with sarcoidosis. However, delayed diagnosis sometimes occurs due to atypical thoracic imaging findings. Patient concerns: A 52-year-old woman presented with recurrent uveitis and fever of unknown origin. She had been admitted to the hospital due to fever, but its cause was not determined. Diagnoses: Chest computed tomography (CT) revealed a solitary pulmonary nodule and an enlarged right axillary lymph node. The nodule had showed an interval growth from 0.7cm to 1.1cm over 18 months, when compared to the previous chest CT. Mosaic attenuation was also observed. Interventions: The patient underwent thoracoscopic wedge resection of the nodule and excisional biopsy of the enlarged lymph node to exclude malignancy and non-caseating granulomas consistent with sarcoidosis was confirmed. Outcomes: Medical treatment with prednisolone and azathioprine was administered. Fever and uveitis no longer recurred after 6 months of medication. We demonstrated that sarcoidosis shows only atypical pulmonary imaging findings, with an enlarged solitary nodule, an axillary lymphadenopathy, and mosaic attenuation, mimicking a malignancy. Lessons: Awareness on atypical CT manifestations that are correlated with pathologic findings may be helpful for early diagnosis of sarcoidosis.