Dyspnoea in a 60 year old man

• Published in: BMJ 2010-07, Vol.341 (jul07 1), p.c3404-c3404
• Main Authors: Gupta, Yuri K, Mazumder, Asif A, Hughes, David V, Howlett, David C
• Format: Article
• Language: English
• Subjects: Abdomen; Anthrax; Biopsy; Biopsy, Needle; Blood tests; Chest; Childrens health; Chronic Disease; Chronic lymphocytic leukemia; Computed tomography; Diagnosis, Differential; Disease; Dyspnea; Dyspnea - etiology; Epstein-Barr virus; Erythema; Erythema nodosum; Fever; Humans; Hypertension; Infections; Leukemia; Leukemia, Lymphoid - pathology; Lung Diseases - diagnostic imaging; Lymphadenopathy; Lymphatic Diseases - diagnostic imaging; Lymphatic system; Lymphocytosis; Lymphoma; Male; Medical diagnosis; Medical imaging; Medical screening; Metastases; Middle Aged; Neck; Non-Hodgkin's lymphoma; Pediatrics; Pelvis; Plague; Pulmonary arteries; Radiography; Respiration; Rubella; Sarcoidosis; Sarcoidosis, Pulmonary - diagnostic imaging; Tomography; Tomography, X-Ray Computed; Tumors; Ultrasonic imaging; Uveitis; Varicella; Viral infections
• ISSN: 0959-8138; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.c3404

The most common cause (70-90% of cases) is sarcoidosis. 2 Half of these patients are asymptomatic and are diagnosed after chest radiography is performed for other reasons. 3 Unless a patient presents with other characteristic clinical findings of sarcoidosis, such as erythema nodosum and uveitis, confirmation by further imaging or biopsy (or both) is usually needed. Bilateral hilar lymphadenopathy is also seen in infections with bacteria such as Bacillus anthracis (anthrax) and Yersinia pestis (plague), often with associated lower lobe airspace opacities, and in viral infection with rubella, Epstein-Barr virus (glandular fever), echovirus, and varicella zoster. 5 6 Of the many cancers that cause hilar adenopathy, lymphoma, leukaemia, and metastases more commonly cause bilateral, as opposed to unilateral, disease. 5 Bilateral hilar lymphadenopathy is more common in Hodgkin's lymphoma than in non-Hodgkin's lymphoma, which often exhibits parenchymal involvement without mediastinal adenopathy. 4 Around 25% of patients with leukaemia have hilar or mediastinal adenopathy, 4 which is more common in lymphocytic forms, particularly chronic lymphocytic leukaemia. Short answer In addition to a chest radiograph, this patient had a full blood count, which showed a lymphocytosis; computed tomography of the chest (fig 3 ), abdomen, and pelvis, which showed bilateral hilar and...