Which are some differential diagnosis to be considered?
The pattern of reticulonodular lung opacities with mediastinal lymphadenopathy in a young female adult is highly suspicious for sarcoidosis. Tuberculosis would be a differential in a correct epidemiological context, and a metastatic disease with lymphangitis carcinomatosis if a history or known primary (e.g. breast). Pneumoconiosis could be a differential if in an older, and commonly male, patient.
Do you know what is the 1-2-3 sign or Garland triad?
It represents a lymph node enlargement pattern which has been described in sarcoidosis: right paratracheal nodes, right hilar nodes, and left hilar nodes.
Can you stage the thoracic sarcoidosis in this patient?
Stage II: nodal enlargement and parenchymal disease
There is a widespread reticular nodular pattern involving both lungs with no areas of consolidation. Apart from pleural scarring in both apices, the pleural spaces are clear. The right paratracheal stripe is demonstrated enlarged and there is a possible right hilar prominent lymph node. There is no pneumothorax or subphrenic free gas. No suspicious bone lesions.