[A case of necrotizing sarcoid granulomatosis diagnosed by open lung biopsy]

A 59-year-old man had an abnormal shadow on chest X-ray film. He was admitted to Tohoku-chuou Hospital, and a lung lesion in the right lower lobe was diagnosed as a benign nodule. A new nodular lesion appeared on a chest X-ray film taken two months after his discharge from the hospital. Both lesions were in the same lobe; the older one was in segment 9 and the newer one was in segment 10. For the lesion in segment 10, malignancy was not ruled out, so open lung biopsy (right lower lobectomy) was done. With the findings of angitis and focal necrosis surrounded by granulomas consisting of epthelioid cells and multinuclear giant cells, the new lesion in segment 10 was diagnosed as necrotizing sarcoid granulomatosis. The older lesion in segment 9 was a tuberculoma. We conclude that in this case the open lung biopsy was necessary to diagnose necrotizing sarcoid granulomatosis in lung.