Sonographically guided biopsy and sonographic monitoring in the diagnosis and follow-up of 2 cases of sarcoidosis with hepatic nodules and inconclusive thoracic findings.
OBJECTIVE
To report 2 cases in which abdominal sonography played a useful role in diagnosing sarcoidosis with early nodular hepatosplenic manifestations.


METHODS
In the first case, an asymptomatic woman with increased liver enzyme values underwent sonography, which showed multiple hypoechoic nodules in the liver and spleen. Computed tomography confirmed the hepatosplenic findings and showed micronodular infiltrates of both lung fields, without hilar and mediastinal lymphadenopathy. In the second case, in a woman with a cough, dyspnea, and increased liver enzyme levels, thoracic computed tomography showed right pleural effusion causing partial atelectasis of the lower and middle lobes and mediastinal lymphadenopathy.


RESULTS
Sonography and computed tomography showed multiple nodules of the liver and spleen and retroperitoneal lymphadenopathy. In both cases, bronchoscopy, bronchial and bronchioloalveolar lavages, and transbronchial and mediastinal biopsies had negative results. Sonographically guided biopsy of the hepatic nodules was carried out and sarcoid granulomas were detected in the portal areas. After 3 months of steroid therapy, liver enzyme values nearly normalized, and sonography showed the disappearance of all abdominal lesions. The first patient underwent control computed tomography, which confirmed the regression of the disease; the second patient refused control computed tomography.


CONCLUSIONS
Sarcoidosis can occur with atypical onset, and in selected cases sonography may play a useful role in its diagnosis and follow-up.
Sartori
Sergio
S
Department of Internal Medicine, St Anna Hospital, Ferrara, Italy.
Galeotti
Roberto
R
Calia
Nunzio
N
Gualandi
Malvina
M
Nielsen
Ingrid
I
Trevisani
Lucio
L
Ceccotti
Piercarlo
P
Abbasciano
Vincenzo
V
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001707:Biopsy, Needle / Q000379:methods; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008107:Liver Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology; D011241:Prednisone / Q000627:therapeutic use; D011282:Pregnenediones / Q000627:therapeutic use; D012507:Sarcoidosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D013158:Splenic Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D011282:Pregnenediones; C021988:deflazacort; D011241:Prednisone