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.