Imaging Case of the Week 127

The following chest x-ray is from a 35 year old who has presented to the ED with fever and multiple joint pains. He has erythema nodosum on examination and has had no prior medical problems. What can be observed on the x-ray?


PA chest x-ray

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The chest x-ray shows a lobulated appearance of the right hilum. There is a nodular soft tissue density in the right tracheobronchial angle. The appearance is suspicious for lymphadenopathy.

CT scan of the chest done later showed bilateral hilar and mediastinal adenopathy, likely secondary to sarcoidosis. The patient also underwent a lymph node biopsy from a supraclavicular node which confirmed the diagnosis of sarcoidosis.

CT Chest


This combination of erythema nodosum, polyarthralgias and bilateral hilar adenopathy is called the Lofgren syndrome, a subtype of sarcoidosis.

Up to 35% of cases of sarcoidosis are Lofgren’s syndrome. It is more common amongst Scandinavians. The prognosis is said to be excellent; treatment is with NSAIDs and short-term bed rest.