Differential Diagnosis for a 74-year-old Man with Dyspnea and Bulky Mediastinal Lymphadenopathy
- Single Most Likely Diagnosis
- A. Small cell lung cancer: This is the most likely diagnosis given the patient's age and the presence of bulky mediastinal lymphadenopathy. Small cell lung cancer is known for its aggressive behavior, early metastasis, and frequent involvement of the mediastinum.
- Other Likely Diagnoses
- B. Hodgkin’s lymphoma: Although more common in younger populations, Hodgkin's lymphoma can occur in older adults and often presents with mediastinal lymphadenopathy.
- C. Lung adenocarcinoma: While not as commonly associated with bulky mediastinal lymphadenopathy as small cell lung cancer, lung adenocarcinoma can also present with lymph node involvement, especially in advanced stages.
- Do Not Miss Diagnoses
- Sarcoidosis: Although less likely, sarcoidosis can cause significant mediastinal lymphadenopathy and can be deadly if missed due to its potential to cause pulmonary fibrosis and cardiac involvement.
- Lymphoma (Non-Hodgkin’s): Various types of non-Hodgkin's lymphoma can present with mediastinal involvement and are critical to diagnose early due to their variable prognosis and treatment options.
- Rare Diagnoses
- D. Thymoma: Thymomas are rare tumors originating from the thymus and can cause anterior mediastinal masses, but they are less commonly associated with bulky lymphadenopathy compared to other diagnoses listed.
- Castleman Disease: A rare disorder that can cause lymphadenopathy, including in the mediastinum, and can be associated with significant morbidity if not recognized and treated appropriately.
- Metastatic Disease from Other Cancers: Although less common, metastasis to the mediastinum from other primary cancers (e.g., breast, testicular) can occur and should be considered, especially if there's a known history of cancer.