928

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.

Atypical Sheldon

The

Thoracic

classic

radiographic

consists

adenopathy. served.

Anterior

ported.

Recent

hilar

hilar

adenopathy

of thoracic paratracheal

sar-

:

,

.

.. ., .

. .

.

in Sarcoidosis

mediastinal

adenopathy

is also

rarely

However,

adenopathy

accompanied

by

in these bilateral

Fig. 1 -A, Frontal radiograph. Subcarinal B, Lateral radiograph also discloses

Received

March

Department 133:928-929,

1 3, 1 979;

accepted

of Radiology,

Albert

November

1979

after

Einstein

locations

hilar

aortopulmonic,

panied

July

Medical

Center,

0361 -8o3x/79/1

and

by hilar

Case M.

This

adenopathy,

retroazygous

or paratracheal

335-0928

unaccom-

adenopathy.

chest

heart

Report N., and

border

a 27-year-old low

(closed

back

black pain.

arrows).

man,

He was

had

otherwise

Also note mass

9, 1979.

Northern

of

re-

soft tissue density alongside right subcarinal mediastinal density.

revision

of intrathosubcarinal,

report

racic

is almost

adenopathy.

illustrates an unusual presentation sarcoidosis, namely, the combination

case

lymph-

node enlargement or the solitary adenopathy is uncommonly ob-

arrow).

AJR

and

studies have revealed that subcarinal, aorand anterior and posterior mediastinal lymphoccurs more commonly than previously thought

topulmonic,

I

:

Lymphadenopathy

manifestation

of bilateral

Unilateral paratracheal

of

finding

always

.

R. Karasick1

coidosis

[1 -3].

.

Division,

$00.00

York

and Tabor

© American

Roentgen

Rds.,

Philadelphia,

Ray Society

PA 19141.

a 2 week

history

asymptomatic

in aortic

pulmonic

of

dull

and

had

window

(open

AJR:133,

November

CASE

1979

929

REPORTS

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Discussion

The occurrence parent pulmonary

of lymph node enlargement without apparenchymal abnormality in sarcoidosis

has

in up to 90%

been

reported

Bilateral hilar and right ment has been considered

of patients

paratracheal a classic

with

the

disease.

lymph node presentation.

enlargeHowever,

several authors have noted that the paratracheal nodes are symmetrically enlarged as demonstrated on chest tomography

[4].

Recently

nopathy [2,

3],

has and

with

tomography,

larged rarely

anterior

been

more

the

more

in many

ade-

in sarcoidosis

use of conventional have

been

However,

absence

mediastinal

observed

nodes

instances.

in the

posterior

frequent

subcarinal

found

and

frequently

of hilar

noted

chest to be en-

subcarinal

nodes

adenopathy

are

[1].

The occurrence of mediastinal adenopathy in the absence of hilar and paratracheal nodes would favor the diagnosis of neoplasm until proven otherwise. The biopsy did not reveal tumor in this case, thereby providing a most unusual radiographic

,,:

.e

,

Fig. 2.-CT recess

,

scan

of thorax.

Soft tissue

adenopathy

I

medical

and

laboratory

Initial

chest

alongside

the

ment

history. results

adenopathy. thy

earlier in

and right

(fig.

the lateral

of sar-

films border

with

ogy

noncaseating

biopsy

on

1). In addition,

heart

thoracotomy

recess

Kate Haney

for manuscript

preparation.

hilar

2).

The

lymph consistent

enlarge1 A).

REFERENCES

density

nodes. with

2.

subcarinal

lymphadenopapatient

1 . Bein

The

or paratrathe

to represent

demonstrated (fig.

node (fig.

any

density

examination

tomography

shown

abnormal

granulomas

lymph

to reveal chest

was

the

window

failed

tomography of the

thank

noncontributory

soft tissue

present

aortopulmonic

conventional

Computed

was

an abnormal not

On

in the azygoesophageal revealed

manifestations

negative.

border

heart

seen

the

were

right

adenopathy.

alongside

examination

revealed

posteroanterior cheal

Physical

radiography

2 years was

thoracic

ACKNOWLEDGMENT

no prior

performed

of the

in azygoesophageal

(cursor).

the

appearance

coidosis.

....

The

pathol-

Putman

3.

Schabel

4.

in sarcoidosis. Fraser AG,

underwent sarcoidosis.

ME,

CE,

McCloud

TC,

Mink

JH:

A reevaluation

intrathoracic lymphadenopathy in sarcoidosis. 415, 1978 Berkmen YM, Javors BR: Anterior mediastinal athy in sarcoidosis. AJR 1 27 : 983-987, 1976

Philadelphia,

SI, Foote

GA,

Radiology

Pare

JAP:

Saunders,

McKee

KA:

Posterior

1 29 : 591 -593, Diagnosis 1 978,

of pp

of

1 31 : 409-

lymphadenop-

lymphadenopathy 1978

Diseases

1665-1667

AJR

of

the

Chest.