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Sarcoidosis

Where Can I Go To Get A Diagnosis?

05/16/2008

Question:

April 2007 thru July 2007 - List of symptoms: Left supraclavicular lymph swollen, (painful for entire period; as well as the one right next to that one (can`t remember the name) for about 2 weeks in that period. I am also very tired and lethargic with dry cough. Primary care ordered blood tests, chest xray, chest CT scan. They told me the blood tests said mono, the chest xray thoracic widening, and the ct showed left chest node enlarged. I went to pulmonary specialist who did bronchioscopy which was inconclusive to diagnosis. No cancer apparently. Specialist said, "It`s probably sarcoidosis." No biopsy of lymph was done, and no granulomas in lungs were found. I was sent on my happy way. Lymph nodes went away until April 2008. Left supraclavicular returned swollen and painful mid April `08 for two weeks, and again now, May 14th `08. I Had another chest CT after seeing primary care. They told me if anything had changed from last CT, they would investigate further. Test results from nurse, "Test came back fine, thanks, bye." I have no idea what to do now. Lymph still swollen, painful, mobile. I am looking to get an actual diagnosis, and don`t know where to go next, or what I should do. My primary care is brushing it off.

Answer:

According to consensus among sarcoidosis experts around the world, a biopsy of the affected tissue is considered to be necessary to confirm the diagnosis of sarcoidosis. It is a diagnosis of exclusion, meaning that other causes, such as infection or lymphoma, have to be considered. There are occasions when biopsy material is not readily available; however, it seems that the enlarged supraclavicular lymph nodes are readily accessible. Thus, I would recommend a biopsy unless it is considered risky for some undisclosed reasons.

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Response by:

Elliott D Crouser, MD Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University