A 35-yr -old woman complains of a painful rash on her legs. She also gives a three-mth history
of dyspnoea on exertion. Her doctor arranged for her to have a CXR and this shows bilateral hilar
prominence. Examination of her legs reveals a purplish-red, nodular tender rash on her shins.
Apart from few bi-basal crepitations on auscultation, systemic examination is normal. A
pulmonary function test shows a mildly impaired DLCO. Which one of the following is the best
investigation to confirm the Dx?
A. Sputum microscopy and culture
B. High-resolution CT scan of the thorax
C. Open lung biopsy
D. Kveim test
E. Serum ACE level
Answer: B) High-resolution CT scan of the thorax
Discussion: This woman has erythema nodosum and bilateral hilar lymphadenopathy. This suggests that she has sarcoidosis. This has a good prognosis.
However, the Dx is clinical as she has dyspnoea and impaired diffusion the lung of carbon monoxide (DLCO), a high-resolution lung scan will establish the Dx.
Whilst Kveim test is the definitive investigation it is rarely done now due to the convenience of high
resolution CT as a viable alternative. Serum ACE, whilst is it likely to be raised, is non-specific.
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