Section: USMLE

44) A 54-year-old African-American woman undergoes a routine insurance physical examination. Chest x-ray film reveals bilateral hilar masses. Biopsy of the masses shows granulomata, but acid-fast and fungal stains are negative for organisms. Which of the following is the most likely diagnosis?

1. Caroli disease
2. Raynaud disease
3. Sarcoidosis
4. Scleroderma
5. Systemic lupus erythematosus

Sarcoidosis is a multisystem disease characterized by noncaseating granulomata in a variety of organs. The disease may be symptomatic (respiratory and constitutional symptoms) or may be discovered incidentally when chest x-ray or autopsy reveals bilateral hilar adenopathy. Definitive diagnosis is based on biopsy, which reveals noncaseating granulomata that are negative for fungi or acid-fast bacilli. Sarcoidosis is more common in individuals of African-American descent.

Caroli disease is a congenital malformation of the bile duct system.

Raynaud disease is a vasospasm of vessels that causes temporary ischemia in the hands.

Scleroderma, or progressive systemic sclerosis, is characterized by progressive fibrosis of skin and internal organs.

Systemic lupus erythematosus is an autoimmune disease characterized by vasculitis (which may produce a variety of symptoms depending on the site of the lesion), rash, renal disease, hemolytic anemia, and neurologic disturbances.