AN UNUSUAL CASE OF SARCOIDOSIS PRESENTING AS A LUNG MASS AND CARDIAC TAMPONADE

TOPIC: Diffuse Lung Disease TYPE: Fellow Case Reports INTRODUCTION: Sarcoidosis is a multisystem granulomatous disease whose etiology remains elusive yet nevertheless has classic pulmonary and extrapulmonary findings that may aid in the diagnosis. The proceeding case demonstrates however difficulty diagnosing this masquerader when rare presentations instead form clinical picture. CASE PRESENTATION: We present 63-year-old male with history of treated active tuberculosis who presented abdominal pain incidentally found to have innumerable bilateral nodules accompanying right hilar mass confluent lymphadenopathy (Figs 1&2). Despite these findings, he denied cough, hemoptysis, dyspnea, fevers, chills, night sweats, weight loss. He had notable particulate exposure as contractor but was otherwise lifetime non-smoker. Diagnostic bronchoscopy endobronchial ultrasound guidance revealed both necrotizing non-necrotizing granulomata no evidence malignancy. Before additional studies could be performed, patient hospitalized at an outside facility for dyspnea cardiac tamponade requiring pericardial drain. Microbiology from his initial grew Cryptococcus prompting empiric fluconazole facility. His parenchymal persisted interval discovery emboli (Fig 3), therapy switched prednisone anticoagulation leading near-resolution nodularity asymmetric lymphadenopathy. DISCUSSION: Pulmonary sarcoidosis generally manifests symmetric, bilateral, micronodules along peribronchovascular bundle interlobular septa or upper middle lobes involvement present. Extrapulmonary occurs much less frequently, often involving lymphatics presenting dermatologic, ophthalmologic, hepatic findings. Our patient's sarcoid unique its appearance basilar predominant seemingly randomly distributed areas confluence mimicking malignant hematogenous dissemination well presence without significant mediastinal involvement. Furthermore, development unprovoked embolism hints highly atypical sarcoid-related thromboembolic only just gaining recognition nascent literature. CONCLUSIONS: In correct epidemiologic context alongside radiographic pathologic correlation, can diagnosed after exclusion etiologies like malignancy, infection, autoimmune disease. However, demonstrates, suspicion most powerful tool synthesizing discordant data rarely seen REFERENCE #1: Criado E, Sanchez M, Ramirez J et al. sarcoidosis: typical manifestation high-resolution CT correlation. Radiographics. 2010;30(6):1567-1586. #2: Ungprasert P, Crowson CS, Matteson EL. Association increased risk VTE: population-based study, 1976-2013. CHEST. 2017;151(2):425-430. #3: Ryu JH, Clinical manifestations, diagnosis, treatment sarcoidosis. Mayo Clin Proc Innov Qual Outcomes. 2019;3(3):358-375. DISCLOSURES: No relevant relationships by Christine Choi, source=Web Response Julien Nguyen, Janine Vintch,