There is bilateral upper zone predominance subcentimetre nodularity with a peri-bronchovascular, fissural and sub-pleural distribution. There is also smooth interlobular septal thickening within the upper zones bilaterally. There are more confluent regions of airspace opacity within the left upper lobe. No pleural effusions.
There is extensive mediastinal lymphadenopathy, the largest of which is a subcarinal node that measures up to 51 mm in maximum diameter. There is also bilateral symmetrical hilar lymphadenopathy. There is a conglomerate mass of enlarged porta hepatis lymph nodes that measure up to 43mm. There are also enlarged lymph nodes adjacent to the superior mesenteric artery. Bilateral axillary lymph node prominence, however these nodes do retain their normal fatty hilum.
Heart size is normal and there is no pericardial effusion appreciated on CT.
No suspicious bony lesion.
Bilateral perilymphatic nodularity with an upper zone predominance, in conjunction with widespread hilar, mediastinal, porta hepatis and para-aortic lymph node enlargement is most in keeping with sarcoidosis given the chronic history provided. Lymphoma is possible but much less likely.