DDX of hilar lymphadenopathy

Approach to the DDX of hilar lymphadenopathy:

  • The most common causes are histoplasmosis, tuberculosis, and leukemia / lymphoma
  • Chest CT can more clearly demonstrate the amount of disease involvement and is better at demonstrating calcification of lung nodules and lymph nodes, the presence of which effectively rules out a diagnosis of malignancy and makes a diagnosis of histoplasmosis much more likely
  • Send a urine culture to look for histoplasmosis
  • Place a PPD to look for tuberculosis
  • If the urine and PPD are negative, consider lymph node biopsy to rule out malignancy