155Lu Sarcoidosis Masquerading as Lung Cancer

52y.o. male, with PMH tobacco use (60py), COPD, spinal surgery, sarcoidosis

7 years ago asymptomatic

Sarcoidosis masquerading as cancer
Normal CXR 7 years ago
Courtesy Paul Kohanteb MD
TheCommonVein.net
Sarcoidosis masquerading as cancer
Normal CXR 7 years ago
Courtesy Paul Kohanteb MD
TheCommonVein.net

2 years ago presented with dyspnea for 2 weeks

CXR

Presents with 2 week history of dyspnea CXR shows hyperinflated lungs iniltrate in the RUL and a small infiltrate in the RLL or RML and prominent right hilum
Courtesy Paul Kohanteb MD
TheCommonVein.net

Emphysematous changes. Multifocal patchy opacities
with consolidation in the right upper lung concerning for multifocal
pneumonia.

CT showed

methotrexate

CT shows hyperinflated lungs emphysema iniltrate in the RUL and a small infiltrate in the RML mediastinal and hilar adenopathy and bilateral pleural effusions
Courtesy Paul Kohanteb MD
TheCommonVein.net
CT shows hyperinflated lungs emphysema iniltrate in the RUL and a small infiltrate in the RML mediastinal and hilar adenopathy and bilateral pleural effusions
Courtesy Paul Kohanteb MD
TheCommonVein.net
CT shows hyperinflated lungs emphysema iniltrate in the RUL and a small infiltrate in the RML mediastinal and hilar adenopathy and bilateral pleural effusions
Courtesy Paul Kohanteb MD
TheCommonVein.net
CT shows hyperinflated lungs emphysema iniltrate in the RUL and a small infiltrate in the RML mediastinal and hilar adenopathy and bilateral pleural effusions
Courtesy Paul Kohanteb MD
TheCommonVein.net
CT shows hyperinflated lungs emphysema iniltrate in the RUL and a small infiltrate in the RML mediastinal and hilar adenopathy and bilateral pleural effusions
Courtesy Paul Kohanteb MD
TheCommonVein.net
CT shows enlarged liver and normal appearing spleen
Courtesy Paul Kohanteb MD
TheCommonVein.net

 

  • 2 Months later
    • right sided lung mass pleural involvement, and extensive adenopathy with
    • RUL Mass
    • RUL infiltrate increased CT 2 months later
      Courtesy Paul Kohanteb MD TheCommonVein.net

       

      • RUL Mass  Mass is Bronchocentric with Obstruction
      RLL Bronchocentric mass increased in size
      CT 2 months later
      Courtesy Paul Kohanteb MD TheCommonVein.net

       

      RLL Mass 

    • RLL Bronchocentric mass increased in size
      CT 2 months later
      Courtesy Paul Kohanteb MD TheCommonVein.net

      Fissures Involved

      Bilateral fissural thickening CT 2 months later
      Courtesy Paul Kohanteb MD TheCommonVein.netThickened Interlobular Septa

      Interlobular septal thickened in the RLL CT 2 months later
      Courtesy Paul Kohanteb MD TheCommonVein.net

       

    • Lymphadenopathy
      Mediastinal and hilar adenopathy
      Courtesy Paul Kohanteb MD TheCommonVein.net

      Lymphadenopathy

      Mediastinal and hilar adenopathy
      Courtesy Paul Kohanteb MD TheCommonVein.net

      Spleen and Liver Negative

      Normal appearing spleen
      Courtesy Paul Kohanteb MD TheCommonVein.net
    • PET positivity suggesting lung cancer with pleural involvement
  • RUL Mass Hyperintense and Lymphadenopathy 
    PET positive RUL mass pleura and lynph nodes bilaterally
    Courtesy Paul Kohanteb MD TheCommonVein.net

     

    • RLL Mass Hyperintense
      PET positive RLL mass pleura and lynph nodes bilaterally
      Courtesy Paul Kohanteb MD TheCommonVein.net

      Lymphadenopathy

      PET positive foregut lymph nodes
      Courtesy Paul Kohanteb MD TheCommonVein.net

      1 year prior PET scan showed

      • extensive hypermetabolic activity associated with
        extensive predominantly
      • pleural-based malignancy in
        • all lobes of thebilateral lungs with
        • some parenchymal involvement and
        • interlobularseptal thickening concerning for
          • lymphangitic carcinomatosis,
      • lymphadenopathy and bilateral pleural effusions which have overall progressed.
  • Pathology form an EBUS 2years ago
    • revealed non-caseating granulomata without malignancy,
    • consistent with sarcoidosis.
      • started on Methotrexate
        • dyspnea worsened .
        • Prednisone 15mg, now down to 10mg.

    • 1 year ago

    • RUL Mass Scar Like
    • RUL mass hass shrunk
      Courtesy Paul Kohanteb MD
      TheCommonVein.net

      RLL Mass Poorly Visualized Because of New Effusion

      RLL mass hass shrunk
      Courtesy Paul Kohanteb MD
      TheCommonVein.net

      Fissures Resolved and New Effusion

      New Effusion
      Courtesy Paul Kohanteb MD
      TheCommonVein.net

      Lymphadenopathy Improved

      Decreasedm Adenopathy
      Courtesy Paul Kohanteb MD
      TheCommonVein.net

       

    • Current on Methotrexate  and Prednisone

    • RUL Mass Scar Like
    • RUL mass remains scar like
      Courtesy Paul Kohanteb MD
      TheCommonVein.net

      RLL Mass Poorly Visualized Because Complex Effusion

      RLL mass persists but smaller
      Courtesy Paul Kohanteb MD
      TheCommonVein.net

       

    • Fissures Resolved
      RLL mass hass shrunk
      Changes in the Fissures have Resolved
      Courtesy Paul Kohanteb MD
      TheCommonVein.net

      Improving Complex Effusion

      Effusion smaller but persists and is complex
      Courtesy Paul Kohanteb MD
      TheCommonVein.net

       

    • Lymphadenopathy Improved
      Decreased Adenopathy
      Courtesy Paul Kohanteb MD
      TheCommonVein.net

      Lymphadenopathy Improved

      Decreased Adenopathy
      Courtesy Paul Kohanteb MD
      TheCommonVein.net