We have another #RadiologyRounds for you today! You are seeing a new patient in the clinic with dyspnea who brings in prior CT chest imaging. A representative coronal image is shown.

In addition to bullous disease, you see bilateral honeycombing with evidence of fibrosis primarily in the upper lung fields.

As part of your evaluation, an EBUS is performed showing the following representative lymph node tissue pathology.

We had evidence of noncaseating granulomas, evidence of fibrocystic changes on chest imaging, and we excluded other causes of granulomatous disease. Given his symptoms and clinical context, we were concerned about Stage IV pulmonary sarcoidosis which can be categorized below.