Sarcoidosis is a multisystem granulomatous disease with polymorphic manifestations, of unknown etiology, that can affect any organ in the body, but most commonly the lungs [1,2,3]. Extrapulmonary involvement is common, can occur in association with or in the absence of intrathoracic disease, and all organs can be involved, but it is rare to find an isolated extrapulmonary disease (less than 10% of patients) [3,4]. On occasion, the presentation of sarcoidosis may be atypical. We report a case of systemic sarcoidosis, with particular clinical data: extrathoracic onset with subdiaphragmatic lymph nodes, hepatomegaly and splenomegaly. Personal history and family history were insignificant.The onset was insidious, with two months prior this admission, with progressive weakness to which weight loss (10 kg) and nonspecific upper abdominal pain were associated later.His physical examination revealed only hepatomegaly and splenomegaly.Laboratory studies indicated biological inflammatory syndrome (ESR, slightly elevated fibrinogen), hypergammaglobulinemia and a negative tuberculin purified protein derivative (PPD ) skin test.Abdominal ultrasound and CT scan documented multiple subdiaphragmatic lymph nodes (periaortic, inter-aorto-caval and iliac), with diameter from 1.75 to 2.5 cm (Figure 1).

Introduction: Early detection of hepatocellular carcinoma is essential to provide effective therapy to high-risk patients, including patients with viral cirrhosis (eg HBV, HCV), haemochromatosis, alpha 1 antitrypsin deficiency or alcohol users. Material and method: The group of patients studied was represented by patients from the records of the Medical Clinic I of the Clinical Hospital “Saint Andrew the Apostle” Constanța for a period of 3 years (2017-2019). We included 82 patients aged between 32 and 82 years (60.22 ± 10.66 years) of which 55 were male and 27 were female. Results: Out of a total of 82 patients, 74 (90.25%) had cirrhosis (CH) and a number of 8 patients (9.75%) had chronic hepatitis without cirrhosis. Child-Pugh stage B had the highest prevalence among patients with hepatic cirrhosis. The etiological factor was hepatitis C virus infection 46 patients (56.1%), followed by hepatitis B virus infection 23 patients (28.05%), 4 patients (4.87%) had double hepatitis virus infection ( HBV + HCV), and 9 patients (10.98%) had a mixed viral and ethanolic etiology. Most of the lesions were located in the right hepatic lobe 58 patients (70.74%), respectively right + left hepatic lobe 22 patients (26.83%) and in 2 patients (2.44%) there were no visualized liver nodules. All patients had parenchymal fibrosis. Conclusions: It is recommended to screen patients with chronic liver disease to assess the risk of developing hepatocellular carcinoma, initially by liver ultrasound that can accurately detect and locate suspected nodules later the definite diagnosis of hepatocellular carcinoma is confirmed by magnetic resonance imaging (MRI).

дані десятирічного проспективного спостереження за 180 пацієнтами з розсіяним склерозом починаючи з перших клінічних ознак захворювання. Визначено клінічні та МРТ-ознаки активності захворювання та їх прогностичне значення. Доведено вплив числа рецидивів, кількості Т2осередків та їх розмірів, локалізації на активність перебігу захворювання, прогресування інвалідизації в різні періоди дослідження.