See original post, to which this followup refers.
Based upon a paper by Winterbauer et al. Ann Intern Med 1979; 78:65 where he examined 5000+ pateints with sarcoidosis, lymphoma, TB, and metastatic ca, I decided to watch.
Of those 5000+, 100 had isolated bilateral hilar adenopathy (no other abnormalities on CXR). 30 of the 100 with bilateral hilar adenopathy were asymptomatic, and all 30 of those had sarcoidosis. This is the basis of the concept of not requiring a biopsy for asymptomatic bilateral hilar adenopathy.
Joe Lynch frequently quoted this paper in clinic, so he was not an advocate for
As someone mentioned in the comments, pelvic lymph nodes occur in sarcoid frequently enough so that we did not go after enlarged lymph nodes in asymptomatic patients.
My big worry is her reduced pulmonary function; however, this could have occurred 4 years ago and I would not have known it.
So my plan: watch her for 3 months and repeat a chest CT (to look at the lymph nodes) and repeat the PFT's. If she has larger LAD or worsening PFT's, she buys a bronch with multiple biopsies to make a diagnosis.
Let me know what you think.
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I never read that paper. Sure, pelvic nodes are common, but I don't know how common upper-abdominal nodes are. In either case, as I previously mentioned, as long as her abdominal symptoms resolved I think observation is fine. If a lymphoma or infection was causing the abdominal pain and was associated with the LAD, I would not expect it to resolve spontaneously.
The choice on 3 months for waiting time seems reasonable. Furthermore, if she has another pathology (e.g. lymphoma) she has had very slow progression and already has disease on both sides of the diaphragm so therapy options won't change much in those 3 months.
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