case_images: PMC6112079_01
case_images: Chest X-ray: multiple bilateral pulmonary masses (white arrows) with right paratracheal lymphadenopathy (yellow arrow).
case_images: CRIRA2018-5686915.001.jpg
case_images: PMC6112079_01_CRIRA2018-5686915.001.jpg
case_images: fig1
case_images: Initial work-up included a chest X-ray which demonstrated multiple bilateral pulmonary masses and right paratracheal lymphadenopathy (Figure 1).
case_images: Axial contrast-enhanced CT obtained at different levels (a, b, c), demonstrating bilateral mass-like ground-glass opacities in a peribronchovascular distribution (arrows) with air-bronchograms and vessels seen coursing through.
case_images: CRIRA2018-5686915.002.jpg
case_images: PMC6112079_01_CRIRA2018-5686915.002.jpg
case_images: fig2
case_images: Further evaluation with chest CT (Figures 2 and 3(a)) revealed discrete, sharply demarcated, mass-like ground-glass opacities involving all lobes bilaterally.
case_images: Coronal reformatted image from contrast-enhanced CT scan, with lung window (a), redemonstrating the findings in Figure 2 (white arrows), and with soft tissue window (b) demonstrating lymphadenopathy in the right paratracheal, bilateral hilar, and subcarinal regions (yellow arrows).
case_images: CRIRA2018-5686915.003.jpg
case_images: PMC6112079_01_CRIRA2018-5686915.003.jpg
case_images: fig3
case_images: Further evaluation with chest CT (Figures 2 and 3(a)) revealed discrete, sharply demarcated, mass-like ground-glass opacities involving all lobes bilaterally. The CT confirmed the right paratracheal lymphadenopathy and also showed bilateral hilar, para-aortic, subcarinal, and prevascular lymphadenopathy (Figure 3(b)).
case_images: PMC6112079_02
case_images: Hematoxylin-eosin stain image from right lower lobe biopsy shows a non-necrotizing granuloma with epithelioid histiocytes (arrowheads) and giant cells (arrows).
case_images: CRIRA2018-5686915.004.jpg
case_images: PMC6112079_02_CRIRA2018-5686915.004.jpg
case_images: fig4
case_images: Fine-needle aspiration of an enlarged right paratracheal lymph node and biopsy of the right lower lobe (Figure 4) both revealed noncaseating granulomas, consistent with sarcoidosis.