An asymptomatic 31-year-old male with patchy infiltrations with air-bronchogram in bilateral upper fields, and bilateral hilar lymphadenopathies on his chest radiograph, was referred in May 2011. The chest computed tomography showed patchy air-space consolidations and small granular opacities in bilateral lungs with mediastinal lymphadenopathies. The positron emission tomography showed increased ¹⁸F-2-deoxy-glucose uptake in cervical, mediastinal, and abdominal lymphadenopathies and nodular opacities in bilateral lungs. The serum angiotensin converting enzyme, the soluble IL-2 receptor, the sialyl Lewis X-i, the neuron specific enolase, and the rate of lymphocyte and CD4/CD8 in bronchoalveolar lavage fluid were increased. A diagnosis required that a biopy from the consolidation and mediastinal lymphadenopathy be done with video-assisted thoracoscopy. Because the pathological findings showed epithelioid cell granuloma without caseous necrosis, and also a multinucleated giant cell, he was diagnosed with sarcoidosis. After the treatment of oral corticosteroids (prednisolone 0.5 mg/kg/day, then tapered), the air-space consolidations, small granular opacities, and lymphadenopathies were gradually improved. In conclusion, there are a few reported cases of “pseudoalveolar sarcoidosis” with pseudoalveolar sarcoid lesions by small granular opacities accumulation in alveolar spaces; therefore sarcoidosis should be considered as one of the differential diagnoses when chest computed tomography shows air-space consolidations and small granular opacities.