0 Hodgkin Disease of the chest

Regarding Hodgkin Disease of the chest:
1. parenchymal disease can be seen in the absence of hilar adenopathy
2. hilar adenopathy can be seen in the absence of mediastinal adenopathy
3. pleural involvement is rare
4. posterior mediastinal adenopathy is common

answer is 3) Hodgkin Disease - Freundlich and Bragg p 352, and Dahnert.
Parenchymal disease is "invariably" subsequent to hilar adenopathy, in fact, if a patient with known Hodgkin has no mediastinal-hilar disease and a new pulmonary nodule appears, it should be presumed to be unrelated and another source should be sought. Hilar adenopathy in the absence of mediastinal adenopathy is rare. Pleural involvement is rare even in the presence of a lymphomatous effusion. Most patients with pleural disease will have contiguous pulmonary or chest wall disease. Lymphadenopathy is nearly always anterior, not posterior, particularly in Hodgkin.

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