PMC9048080_01
Chest radiograph demonstrating bilateral hilar adenopathy.
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Chest radiograph demonstrated hilar prominence but no focal airspace opacities (Fig. 1).
Longitudinal section of computed tomography scan of the chest showing mediastinal lymphadenopathy abutting the esophagus.
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Computed tomography (CT) of the chest was significant for interval development of extensive bilateral paratracheal, subcarinal, and bilateral hilar lymphadenopathy (Fig. 2) consistent with Garland's triad.
Thin cut Axial T1 postcontrast imaging through the internal auditory cancals demonstrates enhancement of the bilateral 7th/8th cranial nerve complexes.
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Magnetic resonance imaging of the brain with and without contrast showed enhancement of the seventh and eight cranial nerves concerning for granulomatous disease or lymphoma (Fig. 3).
EBUS-TBNA of a lymph node (L4: left lower paratracheal lymph node) revealed noncaseating granulomas composed of epithelioid histiocytes. The results of tissue smear, culture, for acid fast bacilli, fungi, and flow cytometry for lymphoproliferative disorder were negative. EBUS-TBNA: endobronchial ultrasound-guided transbronchial needle aspiration (Hematoxylin and Eosin staining, x 200 magnification).
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