Sarcoidosis is a common disease with radiographic findings so characteristic that the diagnosis is often initially suggested by the radiologist. However, atypical clinical or radiographic features such as hoarseness, asymmetric hilar adenopathy, atelectasis, parenchymal masses, or isolated mediastinal adenopathy may be present when the disease has its onset after the age of 50 years. The patient described in this report was initially suspected of having bronchogenic carcinoma, on the basis of her age, radiographic findings, and history of hoarseness. Despite the clinical features for carcinoma at the time of presentation, lymph-node biopsy confirmed a diagnosis of sarcoidosis. Recognition of these atypical radiographic features, coupled with supportive biopsy material, assists in arriving at the correct diagnosis in older patients and helps to avoid confusion with neoplastic or infectious etiologies.
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