What is the significance of multiple subcentimetric pleural nodules in the right upper and lower lobes, described as likely infective, on a High-Resolution Computed Tomography (HRCT) chest scan for a 22-year-old female patient with a 4-day history of fever?

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Last updated: April 15, 2025 • View editorial policy

Differential Diagnosis for a 22-year-old Female Patient with Fever and Pleural Nodules

Single most likely diagnosis

  • Tuberculosis (TB): Given the presence of multiple subcentimetric pleural nodules described as "likely infective" and the patient's symptoms of fever, TB is a strong consideration, especially in regions with high TB prevalence. TB can manifest with pleural involvement, including nodules, and is a common cause of infectious pleural disease.

Other Likely diagnoses

  • Pneumonia with pleural involvement: Bacterial, viral, or fungal pneumonia can lead to pleural nodules, especially if the infection is severe or has spread to the pleura. The description of the nodules as "likely infective" supports this possibility.
  • Pulmonary septic emboli: In the context of fever and pleural nodules, septic emboli should be considered, particularly if there's a source of infection elsewhere in the body, such as endocarditis or an infected intravenous line.
  • Fungal infections: Fungal infections like histoplasmosis or coccidioidomycosis can cause pleural nodules and are more likely in immunocompromised patients or those living in endemic areas.

Do Not Miss (ddxs that may not be likely, but would be deadly if missed)

  • Malignancy (e.g., metastatic disease or lymphoma): Although less likely given the "likely infective" description, malignancy can present with pleural nodules. Missing a diagnosis of malignancy could have significant consequences, so it must be considered, especially if the patient does not respond to antimicrobial therapy.
  • Wegener's granulomatosis (Granulomatosis with Polyangiitis, GPA): This autoimmune disease can cause pulmonary and pleural manifestations, including nodules, and is important to diagnose early due to its potential for severe morbidity.

Rare diagnoses

  • Echinococcosis (Hydatid disease): Caused by the Echinococcus parasite, this disease can lead to cystic lesions in the lungs and pleura, although it's less common and typically associated with specific geographic or exposure histories.
  • Sarcoidosis: While sarcoidosis can cause pulmonary nodules, it less commonly presents with pleural nodules. However, it's a diagnosis to consider in the appropriate clinical context, especially if other findings such as lymphadenopathy or skin lesions are present.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.