CXR Case 033

There are bilateral predominantly mid zone multifocal parenchymal infiltrates, worse on the left.

There is marked coarse fibrosis in the mid zones, worse on the left and affecting the horizontal fissure with some volume loss of the right upper lobe.

This man has longstanding pulmonary and pleural fibrosis from sarcoidosis.

Old CXRs and CTs may help establish if any of the infiltrate is new, suggesting infection

Rarely, patients with progressive, treatment resistant sarcoid are referred for lung transplant.

*More recently some of the monoclonal antibody anti-TNF therapies such as inflixamab and adalimumab have been shown to have some efficacy in sarcoidosis.