Iftikhar Hussain Khan, Mohammad Zubair Shaheen, Mohammad Ali.
Prevalence of Sarcoidosis in isolated mediastinal lymphadenopathy in a tertiary referal centre in Pakistan.
Pak J Chest Med Jan ;11(4):21-5.

Sarcoidosis is an important differential diagnosis in Isolated Asymptomatic or minimally symptomatic Mediastinal lymphadenopathy (IAMLA). Prevalence of Sarcoidosis in such cases in Pakistan is not known but is perceived to be fairly low. Seven patients (5 males and 2 females with mean age of 26 years – range: 18-37 years) presented to us with IAMLA from June 2001 to December 2003. Histopathology of mediastinal nodes, procured via mediastinoscopy, was used to establish the diagnosis. Three of these seven patients (43 %) had Sarcoidosis, two had Tuberculosis, one had Non-Hodgkin Lymphoma while one patient turned out to have metastatic adenocarcinoma. ESR, TLC, Lymphocyte count, Serum Calcium level, Serum ACE levels and pattern of lymph node group involvement on CT scan were unhelpful in establishing diagnosis. We conclude that sarcoidosis is an important diagnosis to be considered in patients with IAMLA. Its prevalence in patients with IAMLA in our study was 43%. This unexpectedly high prevalence needs reconfirmation by a larger study. At the same time, an effort should be made to search for a less invasive but reliable test for confident diagnosis of sarcoidosis. Transbronchial lung biopsy (TBLB), multiple random bronchial biopsies and random skeletal muscle biopsy to pick up non-caseating granulomas appear promising and may be studied for this purpose.

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