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Sarcoidosis — ABIM Board MCQ

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HardPulmonary/Critical CareSarcoidosisABIM Board

A 42-year-old woman has progressive dyspnea, bilateral hilar and mediastinal adenopathy and perilymphatic pulmonary nodules. Infection and lymphoma remain in the differential, so tissue confirmation is required. Which initial sampling procedure is preferred?

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Correct answer: C — Perform EBUS-guided mediastinal and hilar lymph-node sampling

The best answer is “Perform EBUS-guided mediastinal and hilar lymph-node sampling”. When tissue is necessary and mediastinal or hilar adenopathy is accessible, endobronchial ultrasound-guided nodal sampling has high diagnostic yield with substantially less invasiveness than mediastinoscopy. Surgical lung biopsy is unnecessary before less invasive nodal testing, and empiric treatment should not substitute for tissue when infection and malignancy remain credible alternatives.

Reference: ATS Guideline: Diagnosis and Detection of Sarcoidosis: https://pmc.ncbi.nlm.nih.gov/articles/PMC7159433/