Pulmonary sarcoidosis presenting with unusual roentgenographic manifestations

Chest roentgenograms of 85 Jewish patients with biopsy-proven pulmonary sarcoidosis were reviewed. In 25 cases (29%), the initial chest roentgenogram showed one of the following unusual manifestations: large pulmonary nodules in 11, an acinar pattern in 10, right hilar lymphadenopathy in 3 and a large pericardial effusion in one patient. Diagnostic biopsy specimens were obtained by an open lung biopsy in 13 patients, by anterior mediastinoscopy in 4, by transbronchial lung biopsy in 3, by skin biopsy in 3 and by liver and splenic tissue examination in 2 patients. Complete roentgenographic resolution occurred only in 4 out of 20 patients who were followed for more than two years (20%), but the majority of them (83% - 15 out of 18 symptomatic patients), improved clinically irrespective of corticosteroid administration. One patient died in the course of follow-up from a cause attributed to sarcoidosis (5% - one out of the 20 patients who were followed for more than two years).