Situation
A patient presents with a nodule in the left lower lobe that is 2cm, needle biopsy has confirmed non small cell carcinoma. The CT scan reveals mediastinal lymph nodes that are enlarged by CT criteria, so before seeing the patient you decide they will need a mediastinoscopy before any potential resection. When you see the patient they have a had a previous mediastinoscopy 15 years ago when Sarcoid was diagnosed. What would you do ?
Redo mediastinoscopy is possible but potential quite difficult. If the Sarcoid is quiescent then a PET scan may be helpful. If negative then mediastinum is clear, if positive it depends on the state of the Sarcoid. If the Sarcoid is active then the PET will be positive, leaving you in a quandary.