Pneumothorax and multiple lung masses: unusual manifestations of sarcoidosis

Pneumothorax and nodular lung masses are unusual manifestations in thoracic sarcoidosis. We report two cases of pneumothoraces as presenting manifesta tions of sarcoidosis. For the first patient thoracoscopy showed extensive p leural infiltration by noncaseating granulomas as well as subpleural bullae and blebs supporting that necrosis of subpleural granulomas or rupture of blebs/bullae, or both, are the mechanisms of pneumothorax for such patient. The other patient suffered from inaugural pneumothorax with nodular pulmon ary sarcoidosis as bilateral lung masses mimicking metastatic lung cancel: Test of pulmonary function showed no restriction but moderate obstructive d efect. With no treatment the chest radiograph improved and became normal 9 months after the diagnosis suggesting that steroid therapy is not mandatory for such patients.