Differential Diagnosis for Streaky Right Perihilar Infiltrate
- Single Most Likely Diagnosis + Pneumonia: This is the most common cause of a streaky perihilar infiltrate, particularly if the patient presents with symptoms such as cough, fever, and shortness of breath. The perihilar region is a typical location for pneumonia, especially when caused by certain organisms like Streptococcus pneumoniae.
- Other Likely Diagnoses + Pulmonary edema: This condition can cause perihilar infiltrates, often with a batwing or butterfly distribution, and is typically seen in patients with heart failure or fluid overload. + Bronchiectasis: Chronic bronchial infection and inflammation can lead to bronchiectasis, which may present with streaky infiltrates on imaging, particularly if there is associated bronchial wall thickening. + Interstitial lung disease (ILD): Certain types of ILD, such as nonspecific interstitial pneumonia (NSIP) or cryptogenic organizing pneumonia (COP), can present with perihilar infiltrates, although they more commonly have a lower lobe predominance.
- Do Not Miss Diagnoses + Pulmonary embolism: Although less common, pulmonary embolism can present with perihilar infiltrates, particularly if there is associated infarction. This diagnosis is critical to consider due to its high mortality rate if untreated. + Tuberculosis: Especially in endemic areas or in immunocompromised patients, tuberculosis can present with perihilar infiltrates and must be considered to prevent delayed diagnosis and treatment.
- Rare Diagnoses + Lymphangitic carcinomatosis: Metastatic disease to the lungs can cause perihilar infiltrates, particularly if there is lymphatic involvement. This diagnosis is less common but should be considered in patients with a known history of cancer. + Sarcoidosis: This granulomatous disease can cause perihilar lymphadenopathy and infiltrates, although it more commonly presents with hilar lymphadenopathy and upper lobe predominant infiltrates. + Eosinophilic pneumonia: This rare condition can present with perihilar infiltrates, particularly if associated with parasitic infections or drug reactions, and is characterized by eosinophilia on bronchoalveolar lavage.