What is the dominant finding?
Lymph node enlargement of the hila and mediastinum. A few small parenchymal opacities are also present.
What is your favoured diagnosis?
Given the presentation, MRI and CT appearance and demographics sarcoidosis with CNS involvement should probably be the favoured diagnosis. A lymphoproliferative disease (e.g. lymphoma) should also be considered among the more likely possibilities.
There are multiple enlarged mediastinal, hilar and axillary nodes. The largest subcarinal node measures 33.5 by 21.5 x 33.5 mm. The largest right paratracheal node measures 19 mm in short axis diameter and the largest left hilar node measures 17 mm in short axis diameter.
Apart from minor dependent changes and a band in the right middle lobe, lungs and pleural cavities are clear with no evidence of a pulmonary infiltrate.