Multiple bilateral pulmonary nodules masquerading as pulmonary metastasis; a case of nodular sarcoidosis

Abstract

Sarcoidosis is a multi-system inflammatory disorder of unknown etiology that is manifested by the presence of non-caseating granulomas. Multiple pulmonary nodules are rare presentations of sarcoidosis. We report a case of nodular sarcoidosis in a young male of Middle-East origin who had initially presented with bilateral painful ankle edema. His chest X-ray showed multiple bilateral pulmonary nodules. A high resolution computed tomography scan of the chest demonstrated multiple pulmonary nodular lesions and also mediastinal and hilar lymphadenopathy. Subsequent biopsies revealed non-necrotizing granuloma with multi-nucleated giant cells indicative of sarcoidosis. An appropriate work-up was done to confirm the true nature of the nodules and facilitate treatment.

Solitary Pulmonary Nodule: A Diagnostic Dilemma

“…Patients can have fever, myalgia, and weight loss for months without signs of organ involvement [1]. Upper airway symptoms such as epistaxis, recurrent sinusitis, or saddle-nose deformity can be helpful to differentiate it from other forms of vasculitis such as microscopic polyangiitis (MPA) [1–3]. Up to 90 percent of patients with GPA have some form of upper respiratory involvement compared with 35 percent of those with MPA [4].…”

“…Sarcoid nodules usually present as bilateral, multiple opacities occupying the perihilar or peripheral lung zones on a chest CT. These lesions may be accompanied by mediastinal lymphadenopathy and galaxy sign (small satellite nodules that border the periphery of larger nodules) [3]. This patient did not have significant lymphadenopathy, systemic symptoms, or other pulmonary nodules.…”