Bilateral Hilar and Mediastinal Lymphadenopathy

This post is an answer to the case – Patient with Hypercalcemia and Suppressed Parathyroid Hormone Level

A 41-year-old man presented to the emergency department with a 9-month history of cough, exertional dyspnea, nocturnal diaphoresis, and weight loss of 10 kg. The physical examination revealed painless, massive cervical and supraclavicular lymphadenopathy.

Plain radiography of the chest showed bilateral hilar lymphadenopathy. The serum calcium level was elevated at 16.2 mg per deciliter (4 mmol per liter), prompting urgent intravenous administration of normal saline and a bisphosphonate.

Other laboratory testing revealed an elevated lactate dehydrogrenase level of 1143 IU per liter and a serum parathyroid hormone level within the reference range.

Computed tomographic imaging of the thorax, abdomen, and pelvis confirmed supradiaphragmatic lymphadenopathy in the hilar, mediastinal, and axillary regions.

Excisional biopsy of an axillary lymph node established a diagnosis of Hodgkin’s lymphoma, nodular sclerosis subtype. After 8 months of therapy, the patient had a good response to the chemotherapeutic regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine.

He has had no other therapy for the lymphoma but has been treated for complications associated with the chemotherapy.