Which disease classically shows a widened mediastinum and hilar adenopathy with no focal infiltrate on chest X-ray?

Which disease classically shows a widened mediastinum and hilar adenopathy with no focal infiltrate on chest X-ray?

• A. Lymphoma
• B. Anthrax
• C. Tuberculosis
• D. Lung cancer

Answer: (B)

Inhalational anthrax often produces edema and hemorrhagic damage in the mediastinal lymph nodes, leading to widening of the mediastinum on chest X-ray. This pattern can occur with little or no focal air-space disease in the lungs, and hilar lymph node enlargement may be seen as part of the mediastinal process. That combination—widened mediastinum with no focal infiltrate—fits inhalational anthrax best among these options. Other conditions tend to show a parenchymal mass or consolidation (lung cancer), upper-lobe cavitation or infiltrates (tuberculosis), or a discrete mediastinal mass with different radiographic features (lymphoma), rather than the classic dilated mediastinum without lung consolidation. Clinically, a suspected inhalational anthrax requires prompt antimicrobial therapy and public health notification.

Inhalational anthrax often produces edema and hemorrhagic damage in the mediastinal lymph nodes, leading to widening of the mediastinum on chest X-ray. This pattern can occur with little or no focal air-space disease in the lungs, and hilar lymph node enlargement may be seen as part of the mediastinal process. That combination—widened mediastinum with no focal infiltrate—fits inhalational anthrax best among these options. Other conditions tend to show a parenchymal mass or consolidation (lung cancer), upper-lobe cavitation or infiltrates (tuberculosis), or a discrete mediastinal mass with different radiographic features (lymphoma), rather than the classic dilated mediastinum without lung consolidation. Clinically, a suspected inhalational anthrax requires prompt antimicrobial therapy and public health notification.