Answers :
What can you see ?
The radiograph shows bilateral hilar lymphadenopathy (BHL) but no paratracheal lymphadenopathy. The lung fields are otherwise clear.
What is the differential diagnosis ?
The differential includes sarcoid, TB and lymphoma.
As he is fit and well and has no immune compromise, what is the most likely diagnosis ?
The most likely diagnosis is sarcoid in a fit young man. TB is more common in immigrant communities and you would expect a cough. BHL is more common in primary TB in children and not adults. Lymphoma is a possibility but there is no other mediastinal lymphadenopathy or lung masses.
What other clinical features could you look for?
Classic features of sarcoid include erythema nodosum on the shins, fever, arthralgia and uveitis. However some patients are asymptomatic. Most cases will settle without treatment but a small number progress to lung fibrosis.
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