CXR shows bilateral symmetrically enlarged hilar and mediastinal lymph nodes. CT (Fig. 11.2) confirms this finding, typical of sarcoidosis. The main differential diagnoses would be lymphoma and tuberculosis, but the lymphadenopathy would then be asymmetrical. Bronchoscopy and transbronchial lung biopsy are positive in 60% of cases, showing non-caseating granulomas and culture negative for tuberculosis and fungus. Blind endobronchial biopsies increase the yield by another 20% but the gold standard is mediastinoscopy. Incidence in people of African origin is ten times higher than in Caucasians.
Case 12. A 60-year-old male presented at the Emergency Room with severe chest pain of sudden onset. This was his CXR (Fig. 12.1). What is the diagnosis?
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