Sarcoidosis of the Upper Lung Fields Simulating Pulmonary Tuberculosis

¹ Associate Clinical Professor of Medicine, The Mount Sinai School of Medicine, New York
² Clinical Professor of Medicine, The Mount Sinai School of Medicine, New York

Fifty-four of 616 patients (9 percent) with sarcoidosis exhibited upper lung field radiographic abnormalities, which mimicked adult tuberculosis. Difficulty in diagnosis occurred when patients presented with residual upper zonal shadows, which had persisted after clearing of lower and midzonal densities. The abnormalities of sarcoidosis appeared as streaks and nodules simulating acinonodose tuberculosis. Contraction of the upper zones with retraction of the mediastinal structures may be just as prominent as in fibrotic tuberculosis. Bullae can sometimes be mistaken for tuberculous cavities, and small multiple radiolucencies may be mistaken for tuberculous bronchiectasis. Awareness that upper zonal sarcoidosis represents a residual manifestation of the more usual pattern of hilar adenopathy and diffuse lower and midzonal infiltrations, aids in distinguishing this radiographic pattern from that of adult tuberculosis. Obtaining a radiograph dating back to an earlier stage can be crucial in making this differentiation. When confronted with upper lung field abnormalities, the diagnosis of sarcoidosis as well as tuberculosis should come to mind and appropriate clinical support should be sought.

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