Two Cases of Sarcoidosis with Large Nodular Lesions on Chest X-ray Films

Abstract

Two cases of sarcoidosis with large nodular lesions on chest X-ray films are presented. The first case was a 18-year-old female in whom her chest X-ray initially showed infiltration and bronchoscopy test revealed obstruction of left B^4 and B^5 by a white necrotic mass. Since her PPDS was positive, the case was diagnosed as pulmonary tuberculosis, and her general condition showed a tendency to recovery with administration of INH, EB and RFP. However nodular lesions become recognizable on the chest X-ray film. At that time, bronchoscopy demonstrated edema and mucosal dilation, and the histological diagnosis was sarcoidosis. After administration of prednisolone, she recovered completely. The second case was a 20-year-old male, whose chest X-ray film showed bilateral hilar lymphadenopathy and large nodular lesions. Biopsied specimens obtained by transbronchial lung biopsy yielded a diagnosis of sarcoidosis. The incidence of lung nodular lesions in sarcoidosis is less than 4%, and 95% of much cases are patients aged under 40. The present two patients showed acute onset with large nodular lesions in their chest X-ray films. Transbronchial lung biopsy is recommended to obtain a definitive diagnosis in such cases.