should there be further testing

[debbiek09]

diagnosed with sarcoid in the 70's. CXR have always shown bilateral hilar adenopathy. Six weeks ago had upper respiratory infection and have had a residual cough. Had CT of chest with contrast followin CXR that was suspicious for stage II sarcoid. Lyng parenchyma- abnormal interstitial densities in the central upper lobes, perivascular with ill-defined multiple nodules in upper lobes. in left upper lobe ill defined somewhat shaggy nodules of 6-7 mm with at least 12-13 left upper lobe nodules. Smaller left basilar nodules. Abnormal interstitium perihilar and left lower lobe with less prominent small peripheral nodules. Nodules are also seen with multible nodules in the right lung, involving right lower lobe, r middle and r upper lobes. no confluent alveolar infiltrate.
mediastinum- mediastianal and biar hilar adenopathy pretrachael lymph node measuring 19 x 12 mm. 12 mm short axisis and bilar hilar adenopathy as well as subcarinal adenopathy and multiple AP windo lymph nodes.
Upper Abdomen- sm retroperitoneal nodes are seen and periportal nodes

[David Tinkelman, M.D.]

Absolutely yes, these findings warrant further testing.  The majority of individuals who develop sarcoid, characterized by only bilateral hilar adenopathy will experience spontaneous resolution, without recurrence.  A certain, small percentage of individuals with only hilar adenopathy on plain (also called routine) chest X-ray will show abnormalities in the lung substance itself on CT scanning or biopsy.  Thus, it was possible that, over time, you might have had subacute or chronic sarcoid that involved the lungs themselves but, once again, was not evident on the plain X-ray.  This is a real possibility that the nodules you describe are on the basis of sarcoid but it is also plausible that the lesions seen on the recent CT scan are on the basis of another lung disease.

In either event, you and your doctors will have to establish a diagnosis and this must be done, irrespective of your history of sarcoid.  That is to say that, if you never had had the diagnosis of sarcoid, the current lung densities would have to be thoroughly investigated.

In recent years, new diagnostic techniques have been developed to discover the cause of abnormal “shadows” on chest X-rays and CT scans.  Which one of these is most likely to provide a specific diagnosis is dependent upon a number of factors including, but not limited to, the anatomic location of the abnormalities.  The decision, regarding which of these techniques would be best in your situation, would best be made by a lung specialist (pulmonologist) or a thoracic surgeon.  Either of these should be a physician with much experience in the use of one or more of the accepted techniques, likely to be practicing Medicine at a large medical center, some of which with a focus on lung disease, including but not limited to sarcoid.  Many private or university medical centers fit this description.  Your doctors could assist you in finding one of these, if you are already not being seen at one.  My institution is a lung specialty hospital in Denver, National Jewish Health, but there are many others around the country, probably one or more near you, for example the University of California in San Francisco, the Mayo Clinic, The Cleveland Clinic and Johns Hopkins Medical Center.

The key part of this message is that you seek help from medical experts now, without delay.

Good luck

[debbiek09]

Thank you for your response. Only wish I was closer to Denver. I am in VA so I may try Hopkins. Thank you again.