C7) Dry Cough and Dyspnea on Exertion in a Young Female

Review the Learning Outcomes, Hx, PE and Labs, and begin the module with your Provisional Diagnosis. Keep hitting "Next" to move through the module.

Learning Outcomes

  1. Articulate your relationship with the consulting diagnostic radiologists in the evaluation of a patient with cough and weight loss.
  2. Review the DDx considerations in cough and weight loss.
  3. Identify the spectrum of imaging findings in appropriate modalities for evaluating patients with cough and weight loss.


Physical Exam


Provisional Diagnosis

Select the Dx you believe is most appropriate
The constitutional symptoms, dry cough, and dyspnea on exertion are concerning for sarcoidosis with pulmonary involvement. This case is also concerning for extra-pulmonary involvement, including anterior uveitis, lupus pernio, erythema nodosum, restrictive cardiomyopathy, and hypercalcemia from hypervitaminosis from 1-alpha-hydroxylase production.
Well done. You were correct

Potential Acuity

What is your assessment of the likely acuity for this patient?

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While she requires further workup, her condition is not immediately life-threatening.

First Imaging Study

What is the first imaging study you will order?

X-ray is readily available and has low radiation burden. Furthermore, it may reveal characteristic features of sarcoidosis with pulmonary involvement.
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Pertinent Imaging Observations

Click on the links below to view images from the study, and assess these key findings as best you can.

Watch our video

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Second Imaging Study

What is the next imaging study you will order?

Though less sensitive than CT, the chest radiograph in this case showed characteristic manifestations of sarcoidosis for which further clinical workup is warranted.
Well done. You were correct

What is your Diagnosis now that you have seen the imaging results?

The most likely diagnosis is sarcoidosis. However, further workup is required to rule out other similar presenting diagnoses.

Current Acuity

Initially, you selected and we suggested acuity.

Has your concern for this patient changed?

Though her condition is not immediately life-threatening, the patient will require further workup for her condition.

Assessment and Plan

Please provide your assessment and plan for this patient

29-year-old female presenting with clinical symptoms and imaging concerning for sarcoidosis. While lymphoma is part of the differential, it is less likely considering the pulmonary infiltrates and other clinical findings consistent with sarcoidosis. We will obtain ACE levels and consult pulmonology for further workup with possible endoscopic lymph node biopsy.

Lessons Learned: Sarcoidosis is a disease of unclear etiology with noncaseating granulomas on biopsied tissue. It can be diagnosed and staged using chest radiographs. Stage 1) Lymphadenopathy. Stage 2) Lymphadenopathy + interstitial lung disease. Stage 3) Interstitial lung disease with shrinking / unappreciable lymph nodes. Stage 4) Advanced fibrosis. Sarcoidosis must be differentiated from lymphoma, which may present similarly. Once confirmed, sarcoidosis is treated with corticosteroids.

Socioeconomic Factors: CT is not necessary to confirm the presence of sarcoidosis when it is strongly suggested on X-ray.

That's the end of the module! Once you've reviewed the video(s), you can click here for another case challenge.

Kevin Pierre, MD - Editor
Robbie Slater, MD - Supervising Editor
Bayar Batmunh, MS - Coordinator