Differential Diagnosis for Supraclavicular Lymph Nodes in a Patient with Chronic Cough but Normal CT of Lung
- Single Most Likely Diagnosis
- Tuberculosis (TB): Despite a normal CT of the lung, TB can cause supraclavicular lymphadenopathy, especially in the context of a chronic cough. TB can be present with normal imaging if the disease is extrapulmonary or if the pulmonary involvement is minimal.
- Other Likely Diagnoses
- Sarcoidosis: This condition can cause lymphadenopathy, including in the supraclavicular region, and can present with a chronic cough. Sarcoidosis may not always show significant findings on a CT scan, especially if it's in its early stages.
- Lymphoma: Both Hodgkin's and non-Hodgkin's lymphoma can present with lymphadenopathy in the supraclavicular area. A chronic cough could be a symptom of mediastinal involvement, even if the lung parenchyma appears normal on CT.
- Metastatic Cancer: Although the CT of the lung is normal, cancers from other primary sites (e.g., breast, abdomen, or pelvis) can metastasize to supraclavicular lymph nodes. A thorough investigation for a primary tumor is necessary.
- Do Not Miss Diagnoses
- Thyroid Cancer: Metastasis to supraclavicular lymph nodes from thyroid cancer can occur, and it's crucial not to miss this diagnosis due to its implications for treatment and prognosis.
- Mediastinal Germ Cell Tumors: These rare tumors can present with lymphadenopathy and systemic symptoms like cough, even without obvious lung involvement on imaging.
- Rare Diagnoses
- Castleman Disease: A rare disorder that can cause lymphadenopathy, including in the supraclavicular region, and may present with systemic symptoms such as cough.
- Kikuchi-Fujimoto Disease: A rare, self-limiting condition that can cause lymphadenopathy, typically in the cervical region, but can occasionally involve supraclavicular nodes, and may be accompanied by a cough among other symptoms.
- Silicosis or Other Occupational Lung Diseases: Although the CT is normal, long-term exposure to certain substances can lead to lymphadenopathy and systemic symptoms like cough, even in the absence of obvious lung changes on imaging.