Differential Diagnosis
- Single most likely diagnosis
- Metastatic disease: The presence of multiple pulmonary nodules and masses of varying sizes, along with mediastinal adenopathy, is highly suggestive of metastatic disease. The patient's history of a recent abnormal chest radiograph and the findings on the CT scan, including a large soft tissue mass lesion in the left lower lung, support this diagnosis.
- Other Likely diagnoses
- Primary pulmonary neoplasia (lung cancer): The CT scan findings of multiple nodular and irregular mass lesions, including spiculated masses, are consistent with primary lung cancer. The patient's history of emphysema and chronic bronchitis also increases the risk of developing lung cancer.
- Lymphoma: The presence of mediastinal adenopathy and multiple pulmonary nodules could be indicative of lymphoma, particularly if the patient has a history of immunosuppression or other underlying conditions.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Infectious diseases (e.g., tuberculosis, fungal infections): Although less likely, infectious diseases could present with similar findings, particularly in immunocompromised patients. Missing these diagnoses could lead to delayed treatment and poor outcomes.
- Sarcoidosis: This condition can cause mediastinal adenopathy and pulmonary nodules, and although less likely, it is essential to consider it in the differential diagnosis to avoid missing a potentially treatable condition.
- Rare diagnoses
- Pulmonary arteriovenous malformations (PAVMs): Although rare, PAVMs could present with multiple pulmonary nodules and masses, particularly if they are associated with hereditary hemorrhagic telangiectasia.
- Pulmonary amyloidosis: This condition can cause nodular lesions in the lungs, although it is relatively rare and would require further evaluation to confirm the diagnosis.