RADIOLOGY OF THE MONTH

ALVEOLAR SARCOIDOSIS WITH LACRIMAL GLAND INVOLVEMENT

By
Maha Mahmoud, Mamdouh Mahfouz

History: A 44 -year- old male presented with orbital pain and lid swelling for 3 weeks. He complained of pain, redness, and irritation in both eyes and received medical treatment with mild improvement. Three days latter he experienced acute onset of diminution of vision. He had no systemic complaints. Slit lamp examination revealed no abnormality. The upper lids of both eyes were swollen and a firm mass was felt on the supero-lateral aspect of the orbits. The lid swelling was secondary to orbital mass. The mass was immobile and non-tender. Therefore, the patient underwent Computerized Tomography (CT) scan of the orbit that showed bilateral almost symmetrical lacrimal gland enlargement, operative biopsy was recommended.
Prior to biopsy, chest X-ray was performed and showed bilateral pulmonary opacities, though there was no clinical respiratory abnormality. Consequently CT scan of thorax was done that revealed multiple alveolar opacities.
Laboratory investigations showed a normal haemogram, erythrocyte sedimentation rate  70-mm at first hour ,serum angiotensin converting enzyme (ACE) level was 42 units (normal: 14-70 units), intradermal purified protein derivative test for Mycobacterium tuberculosis was negative (3-mm induration), rheumatoid factor, uric acid and thyroid hormone levels were normal.

                                                                                                                                                               
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