A case report: Endobronchial ultrasound guided biopsy of radiographically normal size thoracic lymph nodes supporting diagnosis of cardiac sarcoidosis

Sarcoidosis is a rare chronic granulomatous disease with unknown etiology. Definite diagnosis of cardiac sarcoidosis (CS) is especially difficult to establish. Several guidelines exist to make a diagnosis of CS but those have not been clinically validated. Despite the high specificity of endomyocardial biopsy, its sensitivity is low, and the severity of potential complications is high. Thus, we present 63-year-old male who was diagnosed with CS with the endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) of intrathoracic lymph nodes which were non-enlarged without PET avidity. EBUS TBNA of radiographically normal appearing lymph nodes showed non-necrotizing granulomas. Given challenges of diagnosing CS, EBUS TBNA can be considered even in cases without obvious evidence of active pulmonary sarcoidosis.