Question 264

Question:

A 34-year-old woman has had a nonproductive cough for 2 months. She has never smoked. An x-ray of the chest shows bilateral interstitial markings and hilar adenopathy. Which of the following findings is most likely on the transbronchial biopsy?

Correct Answer: E.  Noncaseating granulomas

This woman’s clinical and radiographic history is consistent with the diagnosis of sarcoidosis. Sarcoidosis is characterized by widespread noncaseating granulomas, elevated serum ACE levels, and is associated with, among other things, restrictive lung disease.

(A) Pulmonary hemorrhage is unlikely. There is no history of hemoptysis or evidence of hemorrhage on chest x-ray.

(B) Liquefactive necrosis is often associated with cellular destruction, often secondary acute infection.

(C) There is no suggestion of bronchiectasis or dilation of the respiratory bronchioles on history or radiography.

(D) Bacterial infection with abscess formation is unlikely given this woman’s clinical history and radiographic findings.