Autopsy Findings

Gross appearances: The heart (370 g, normal 267 g) showed biventricular hypertrophy (RV 7 mm, LV 18 mm thick, normal 5 and 15 mm, respectively) but no dilation. The proximal pulmonary arteries showed fatty streaks similar to those in the aorta, indicating increased pressure in the pulmonary circuit. The trachea had hemorrhagic plaques, 2-3 mm in diameter. Bronchial mucosa showed diffuse nodularity, 2-4 mm in diameter, and some hemorrhages.

The lungs (R 725, L 425 g) have peribronchial and pleural nodules, some confluent, upper lobes >>lower lobes. Interlobular septa are spared. There is no emphysema or fibrosis. The bronchi to the right lower lobe (arrow) are filled with blood, and the lobe is consolidated by blood. Hilar and paratracheal lymph nodes are enlarged to 2.2 cm, grey, and firm.

 

Note the marked thickening of the wall of the bronchus to the right middle lobe (arrow). The mucosa is slightly hyperemic and shows nodular thickenings that narrow the lumen. As is characteristic in sarcoidosis, the lymph nodes are discrete, and not matted together by perinodal connective tissue.

Clinical summary Image 2

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