Chest X-ray ward round

Series 1: Case 7 Questions

Case 7:

A 53-year-old presents with a dry cough and erythematous tender nodules on his legs

Chest CXR (Click to enlarge)

Questions:

What does the X-ray show?

Bilateral hilar lymphadenopathy

What is the diagnosis and differentials?

Sarcoidosis

Other causes include:

Infection (TB, mycoplasma, histoplasmosis)
Malignancy: lymphoma, carcinoma
Inorganic dust disease (silicosis, berylliosis)

What is the management?

Investigations:

CT chest with high resolution reconstruction
Pleural fluid aspiration, image guided pleural biopsy

Treatment:

Pleural plaques are usually benign and require no treatment
If mesothelioma depending on fitness to decide on systemic treatment

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