Differential Diagnosis for Pulmonary Hilar Adenopathy with Noncaseating Granuloma

• Single Most Likely Diagnosis
  • Sarcoidosis (c): This condition is characterized by the presence of noncaseating granulomas in various organs, including the lungs, and often presents with pulmonary hilar adenopathy. The combination of these two findings makes sarcoidosis the most likely diagnosis.
• Other Likely Diagnoses
  • Hodgkin’s Disease (a): Although less common than sarcoidosis, Hodgkin’s lymphoma can present with hilar adenopathy and noncaseating granulomas, particularly in the nodular sclerosis subtype.
  • Lymphoma (b): Non-Hodgkin lymphoma can also cause hilar adenopathy, and while noncaseating granulomas are less typical, they can be seen in certain subtypes.
• Do Not Miss Diagnoses
  • Tuberculosis (d): Although caseating granulomas are more typical of tuberculosis, noncaseating granulomas can occasionally be seen, especially in atypical or early presentations. Missing tuberculosis could have significant consequences due to its infectious nature and the availability of effective treatment.
  • Metastatic Carcinoma (e): While less likely to present with noncaseating granulomas, certain metastatic carcinomas can cause hilar adenopathy. The potential for malignancy makes this a "do not miss" diagnosis, despite its lower likelihood.
• Rare Diagnoses
  • Other Granulomatous Diseases: Conditions like berylliosis, histoplasmosis, and other rare infections or exposures can cause noncaseating granulomas and hilar adenopathy but are less common than the aforementioned diagnoses.
  • Immunodeficiency-Associated Granulomatous Disease: In patients with immunodeficiencies, unusual granulomatous reactions can occur, presenting with noncaseating granulomas and hilar adenopathy. These are rare and typically associated with specific clinical contexts.