Presentation
Cough for six months. No fevers.
Patient Data
Right hilar mass and multiple bilateral lung nodules are identified. Cardiac silhouette is not enlarged.
Bilateral pulmonary nodules without cavitation or calcification. Scattered randomly throughout both lungs. Enlarged pretracheal lymph and right hilar nodes. No evidence of interstitial disease.
After a negative EBUS the patient proceeded to a CT guided pulmonary nodule biopsy.
HISTOPATHOLOGY
MICROSCOPIC DESCRIPTION: Sections show non-necrotizing granulomatous inflammation in a background of dense fibrous tissue. No normal lung parenchyma is identified. The adjacent bronchial epithelium appears intact. ZN, Fite, PAS and Grocott stains are negative. There is no evidence of dysplasia or malignancy.
DIAGNOSIS:
Lung core biopsy: Non-necrotizing granulomatous inflammation. Features favoring sarcoidosis.
Case Discussion
The differential diagnosis for random pulmonary nodules includes:
- nodular pulmonary metastases
- infection, e.g. tuberculosis
- sarcoidosis
- silicosis