The Daily PANCE and PANRE Question 44

An 18-year-old female presents after completing her freshman year at college. Two months ago, she developed "bronchitis" which has persisted. She has become increasingly tired and has frequent night sweats. A chest x-ray today reveals a left mediastinal mass. What is the next step in her evaluation?

  1. repeat the chest x-ray in six months
  2. ultrasound of the left hemithorax
  3. bone scan
  4. CT scan of the chest
  5. proceed directly to bronchoscopy with biopsy

Answer: D

CT scan of the chest

Any patient presenting with mediastinal nodes should have a CT. This patient may have sarcoid or Hodgkin's or another type of cancer - CT is indicated.

If you see hilar lymphadenopathy it is right to think Sarcoidosis, but not always. Here is a rough guide to approaching hilar adenopathy (click here)

  • Young female = Sarcoidosis
  • Young kid with a fever, from Ohio, zookeeper =  histoplasmosis 
  • An old guy in his 60’s works on ceramics = Berylliosis

Know Your Content Blueprint

There are 32 respiratory disorders covered in  NCCPA™ Content Blueprint Pulmonology System (12%)

Browse the Content Blueprint and learn more about sarcoidosisHodgkin's Lymphoma other causes of hilar lymphadenopathy such as histoplasmosis.

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