The Question is from neet-botany , and it was created by the author Mr. NARESH KUMAR K

Question

A 55-year-old male presents with progressive dyspnea, cough, and weight loss.  A chest X-ray reveals bilateral hilar lymphadenopathy and interstitial infiltrates.  Bronchoscopy with transbronchial biopsy shows non-caseating granulomas.  Which of the following is the MOST likely diagnosis?

Mr. NARESH KUMAR K · Accepted Answer

## CORE INFORMATION
✓ **Answer**: A
## CONCEPT FRAMEWORK
 **Primary Concept**: Differential diagnosis of interstitial lung disease with hilar lymphadenopathy.
 **Related Topics**: Sarcoidosis, Tuberculosis, Hypersensitivity pneumonitis, Lymphoma, Non-caseating granulomas, Chest X-ray findings.
 **Prerequisites**: Understanding of common pulmonary diseases, interpretation of chest X-ray findings, and knowledge of granulomatous diseases.
## SOLUTION PATHWAY
**Given Information**:
  * 55-year-old male
  * Progressive dyspnea, cough, and weight loss
  * Bilateral hilar lymphadenopathy on chest X-ray
  * Interstitial infiltrates on chest X-ray
  * Non-caseating granulomas on transbronchial biopsy
  [Important conditions]: The presence of non-caseating granulomas is key.
**Method & Steps**:
 1. Analyze the clinical presentation:
  Reasoning: The patient presents with classic symptoms of interstitial lung disease (dyspnea, cough, weight loss) and imaging findings consistent with several conditions.
  Formula/Rule: None directly applicable.
 2. Interpret the biopsy results:
  Working: Non-caseating granulomas are a hallmark of sarcoidosis. While other diseases can present with granulomas, the absence of caseation (cheese-like necrosis) makes tuberculosis less likely.
  Key Point:  The absence of caseation is crucial in differentiating sarcoidosis from tuberculosis.
 3. Consider the differential diagnosis and weigh the likelihood:
  Result: Sarcoidosis is the most likely diagnosis given the combination of clinical presentation, radiological findings, and the presence of non-caseating granulomas.
  Verification: The other options are less likely. Tuberculosis typically presents with caseating granulomas. Hypersensitivity pneumonitis might show interstitial infiltrates but usually lacks hilar lymphadenopathy. Lymphoma can cause lymphadenopathy but usually doesn't present with non-caseating granulomas and the specific clinical picture.
 ## OPTION ANALYSIS
A ✓: Sarcoidosis is the most likely diagnosis due to the presence of bilateral hilar lymphadenopathy, interstitial infiltrates, and non-caseating granulomas on biopsy.  This constellation of findings is highly suggestive of sarcoidosis.
B :x: Tuberculosis can cause similar findings, but the absence of caseating granulomas makes it less likely.
C :x: Hypersensitivity pneumonitis is less likely given the bilateral hilar lymphadenopathy.
D :x: Lymphoma can present with lymphadenopathy, but the presence of non-caseating granulomas makes it less probable.
 ## LEARNING AIDS
 **Common Mistakes**:
  1.Confusing sarcoidosis with tuberculosis: Remember the key difference in granuloma type (caseating vs. non-caseating).
  2.Overlooking the significance of non-caseating granulomas: This finding is crucial for the diagnosis of sarcoidosis.
 **Quick Tips**:
  1.  When you see bilateral hilar lymphadenopathy and interstitial infiltrates on CXR, consider sarcoidosis high on your differential.
  2.  Non-caseating granulomas strongly suggest sarcoidosis.

Mr. NARESH KUMAR K · Answer

The correct Option is "Sarcoidosis"

Mr. NARESH KUMAR K · Answer

Tuberculosis

Mr. NARESH KUMAR K · Answer

Hypersensitivity pneumonitis

Mr. NARESH KUMAR K · Answer

Lymphoma

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