Endgames Spot Diagnosis

Constitutional symptoms in a young person

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5781 (Published 07 December 2016) Cite this as: BMJ 2016;355:i5781
  1. Sarah Hancox, foundation year 2 doctor1,
  2. David Howlett, consultant radiologist1
  1. 1East Sussex Healthcare Trust, Eastbourne District General Hospital, King’s Drive, Eastbourne, UK
  1. Correspondence to: S Hancox sarahhancox{at}nhs.net

A 25 year old woman presented to her general practitioner with recent weight loss and night sweats. On examination she had palpable cervical lymphadenopathy, and a chest radiograph was obtained (fig 1). What does this radiograph show? What is the differential diagnosis?

Fig 1 Chest radiograph

Answer

The chest radiograph (fig 2) shows an anterior mediastinal mass with changes to aortopulmonary soft tissue (A and B) —consistent with mediastinal lymphadenopathy.

Fig 2 Chest radiograph showing mediastinal lymphadenopathy. A and B show nodal enlargement outside the normal mediastinal borders. …

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