A 25 year old man presented with fever, cough, expectoration and breathlessness of 2 months duration. Contrast enhanced computed tomography of the chest showed bilateral upper lobe fibrotic lesions and mediastinum had enlarged necrotic nodes with peripheral rim enhancement. Which one of the following is the most probable diagnosis:
Answer is B (Tuberculosis) : Most common cause of necrotic lymph nodes with peripheral rim enhancement is tuberculosis. Peripheral rim enhancement is seen in most granulomatous lymphadenopathies. Most common cause of necrotic lymph nodes with peripheral rim enhancement is Tuberculosis - In tuberculosis affected lymph nodes show relatively low attenuation of their central region and peripheral rim enhancement after I.V. contrast material - In Sarcoidosis lymph nodes are not necrotic and calcification is uncommon Expectoration is a major manifestation in tuberculosis. It is usually not associated sarcoidosis, silicosis and lymphoma. Cough and bilateral upper lobe fibrosis makes lymphoma unlikely. It may be seen in the other conditions. The only condition satisfying all the clinical features mentioned in the question is tuberculosis and hence is the answer of choice.
Sarcoidosis
Tuberculosis
Lymphoma
Silicosis