CTICasesB-Cell Lymphoma Mimicking Sarcoidosis
Imaging findings
Chest radiograph shows an abnormal left hilar and upper mediastinal contour with obliteration of the aortopulmonary window. Contrast-enhanced CT confirms bulky, strikingly asymmetric lymphadenopathy restricted exclusively to the left anterior mediastinal and left hilar regions, with a complete absence of right-sided mediastinal or hilar adenopathy.
Key takeaways
Although sarcoidosis is a common cause of mediastinal and hilar lymphadenopathy, it classically presents with highly symmetric, bilateral hilar and right paratracheal adenopathy. Unilateral or highly asymmetric mediastinal lymphadenopathy (especially involving the anterior mediastinum) is highly atypical for sarcoidosis and must be treated as suspicious for neoplastic processes such as lymphoma, necessitating tissue biopsy.
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