Differential Diagnosis for Mediastinal Adenopathy and Pulmonary Nodules
Single Most Likely Diagnosis
- Metastatic Malignancy: Given the presence of numerous pulmonary nodules and masses bilaterally, with sizes ranging from a few millimeters to 7.4 cm, and the presence of spiculated nodules, metastatic malignancy is the most likely diagnosis. The history of post median sternotomy changes and coronary artery bypass grafting suggests a possible history of cancer or other conditions that may increase the risk of malignancy.
Other Likely Diagnoses
- Sarcoidosis: This condition can cause mediastinal adenopathy and pulmonary nodules, although the presence of spiculated nodules and large masses makes it less likely.
- Lymphoma: Can cause mediastinal adenopathy and pulmonary involvement, but the pattern of disease described is more suggestive of metastatic disease.
- Infectious Diseases (e.g., Tuberculosis, Fungal Infections): While these can cause pulmonary nodules and adenopathy, the presence of over 60 nodules and masses, including large ones, makes this less likely.
Do Not Miss Diagnoses
- Pneumonia: Although the description does not strongly support pneumonia as the primary diagnosis due to the minimal consolidative infiltrates and the presence of numerous nodules and masses, it's crucial not to miss pneumonia, especially in the context of immunocompromised patients or those with significant comorbidities. The patient's history of coronary artery bypass grafting and chronic bronchitis increases the risk of pneumonia.
- Vasculitis (e.g., Wegener's Granulomatosis): This can cause a wide range of pulmonary and mediastinal findings, including nodules and adenopathy, and is important not to miss due to its potential for severe consequences if untreated.
Rare Diagnoses
- Langerhans Cell Histiocytosis: A rare condition that can cause pulmonary nodules and cysts, but typically does not present with the pattern of large masses and spiculated nodules described.
- Amyloidosis: Can cause pulmonary nodules, but this would be an unusual presentation and other systemic symptoms would likely be present.
- Pulmonary Arteriovenous Malformations: Could cause nodular lesions, but the clinical context and the presence of adenopathy make this less likely.