The usual unusual manifestations of sarcoidosis and the 'hilar haze': a new diagnostic aid

The late and more unusual features of pulmonary sarcoidosis are discussed in relation to their significance and roentgenographic appearance. The atypical manifestations of lymphadenopathy encountered were unilateral presentation, bilateral mediastinal presentation, and anterior mediastinal presentation. Calcified lymph nodes were noted in approximately 5% of cases. The pulmonary patterns described were miliary nodular, alveolar, atelectasis, and fibrocystic disease. Pleural effusion was found in a high percentage of cases and, surprisingly, 2 patients had fibrothorax. One patient demonstrated a systemic pulmonary artery shunt on arteriography. Of particular diagnostic interest is the 'hilar haze', a term that the authors have introduced to describe the changes that occur around the hilum. This sign appears to be relatively specific and has proven to be quite useful in the differential diagnosis of this disease.