Necrotic mediastinal lymphadenopathy: Tuberculosis or Sarcoidosis, a diagnostic conundrum - A case report and review of the literature

Sarcoidosis is an uncommon disease involving pulmonary parenchyma and lymph nodes. Non-necrotizing, bilaterally symmetric hilar, and right paratracheal lymph nodes are the pathognomonic imaging features of sarcoidosis. Rarely, atypical radiological findings of sarcoidosis may mimic mycobacterial infections, posing a diagnostic dilemma, especially in tuberculosis endemic countries. In this report, we have discussed the case of a 61-year-old female presenting with multiple conglomerated necrotic mediastinal lymph nodes on computed tomography that looked tubercular but eventually turned out to be sarcoidosis. It is important for primary care physicians, who are the first point of contact for patients, to keep in mind the atypical radiologic manifestations of sarcoidosis, in order to reach a timely diagnosis and help reduce the associated morbidity and mortality.