Case 1
A 35-year-old female presents with fatigue.
1. What is the main abnormality?
a) Lung parenchymal abnormality
b) Pleural abnormality
c) Bony abnormality
d) Lymphadenopathy
e) Normal appearances
Case 2
A 41-year-old female intravenous drug user presents with fever and cough.
1. Which of the following is the most probable cause for these radiographic appearances?
a) Pulmonary infarcts
b) Pulmonary tuberculosis
c) Sarcoidosis
d) Fungal infection
e) Metastases
Answers
Case 1
1. d) Lymphadenopathy. There is bilateral hilar lymphadenopathy in this patient who was diagnosed with stage 1 sarcoidosis. In addition, there are enlarged nodes within the aorto–pulmonary window and right paratracheal region.
The main differential diagnoses for mediastinal lymphadenopathy include:
Sarcoidosis | Typically results in bilateral symmetrical involvement of hilar and paratracheal nodes. |
Tuberculosis | Usually unilateral and associated with ipsilateral parenchymal disease. |
Lymphoma | Typically results in bilateral asymmetrical lymphadenopathy and frequently affects the anterior mediastinal and retrosternal nodes. |
Neoplasia | Due to nodal disease spread. Most commonly primary bronchogenic carcinoma, usually unilateral and can be very extensive with small cell carcinoma. Also occurs with nodal spread from other primary cancers including oesophagus, breast and thyroid. |
Case 2
1. b) Pulmonary tuberculosis. The main abnormality is the presence of multiple small miliary nodules throughout both lungs (blue arrows in the figure) …