Differential Diagnosis for Shotty Mediastinal Nodes
Single Most Likely Diagnosis
- Sarcoidosis: This is a common cause of shotty (small, numerous) mediastinal lymph nodes, often presenting with bilateral hilar lymphadenopathy. Sarcoidosis is a systemic granulomatous disease that can affect multiple organs, including the lungs and lymph nodes.
Other Likely Diagnoses
- Lymphoma: Both Hodgkin's and non-Hodgkin's lymphoma can cause mediastinal lymphadenopathy, which may appear as shotty nodes on imaging. The presence of systemic symptoms such as fever, night sweats, and weight loss can support this diagnosis.
- Tuberculosis (TB): TB can cause lymphadenopathy in the mediastinum, which may appear shotty, especially in the early stages of the disease. A history of exposure, systemic symptoms like fever and weight loss, and radiographic findings can suggest TB.
- Histoplasmosis: This fungal infection can cause mediastinal lymphadenopathy, particularly in individuals who have been exposed to the fungus, often through occupational or recreational activities involving soil or bird droppings.
Do Not Miss Diagnoses
- Lymphoma with Mediastinal Involvement: Although listed under other likely diagnoses, it's crucial to emphasize that missing a diagnosis of lymphoma can have significant consequences due to its potential for rapid progression and the importance of early treatment.
- Tuberculosis with Mediastinal Involvement: Similar to lymphoma, TB is a critical diagnosis not to miss due to its potential for severe consequences if left untreated, including spread to other parts of the body and development of drug resistance.
Rare Diagnoses
- Castleman Disease: A rare disorder that involves an overgrowth of cells in the body's lymph nodes, which can cause mediastinal lymphadenopathy. It can present in a localized or multicentric form, with the latter often associated with more systemic symptoms.
- Kikuchi-Fujimoto Disease: A rare, self-limiting condition that can cause lymphadenopathy, including in the mediastinum. It is more common in young women and often presents with fever and night sweats.
- Silicosis or Other Occupational Lung Diseases: In individuals with a history of exposure to silica or other harmful dusts, these diseases can cause mediastinal lymphadenopathy among other pulmonary findings.