Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Feger J, Silverstone L, et al. Mediastinal lymph node enlargement. Reference article, Radiopaedia.org (Accessed on 04 Oct 2024) https://doi.org/10.53347/rID-30544
Mediastinal lymph node enlargement can occur from a wide range of pathologies and can be isolated or associated with lung pathology. Historically, a size cut-off of 10 mm short-axis diameter was used.
The term mediastinal lymphadenopathy implies lymph node disease and is not synonymous with mediastinal lymph node enlargement. Enlarged lymph nodes may be simply reactive as in most bacterial pneumonia, or diseased due to invasion by e.g. tuberculosis or cancer. Ideally, the term lymphadenopathy would be applied only to diseased lymph nodes however this distinction may require pathological analysis. Moreover, the disease begins in normal-sized lymph nodes which enlarge with disease progression.
The spectrum of conditions that can result in mediastinal lymphadenopathy is extremely diverse and includes:
If incidentally detected, the ACR committee white paper in 2018 suggests clinical consultation, further workup with CT-PET +/- follow up CT chest in 3-6 months if the short-axis diameter is over 15 mm and if there is no explicable disease 9. Interval size increase on ffollow-updictates the need for biopsy.
-
1. Goldberg S, Raptopoulos V, Boiselle P, Edinburgh K, Ernst A. Mediastinal Lymphadenopathy: Diagnostic Yield of Transbronchial Mediastinal Lymph Node Biopsy with CT Fluoroscopic Guidance-Initial Experience. Radiology. 2000;216(3):764-7. doi:10.1148/radiology.216.3.r00se32764 - Pubmed
-
2. Boiselle P, Patz E, Vining D, Weissleder R, Shepard J, McLoud T. Imaging of Mediastinal Lymph Nodes: CT, MR, and FDG PET. Radiographics. 1998;18(5):1061-9. doi:10.1148/radiographics.18.5.9747607 - Pubmed
-
3. Suwatanapongched T & Gierada D. CT of Thoracic Lymph Nodes. Part II: Diseases and Pitfalls. Br J Radiol. 2006;79(948):999-1000. doi:10.1259/bjr/82484604 - Pubmed
-
4. Kumar A, Dutta R, Kannan U, Kumar R, Khilnani G, Gupta S. Evaluation of Mediastinal Lymph Nodes Using F-FDG PET-CT Scan and Its Histopathologic Correlation. Ann Thorac Med. 2011;6(1):11-6. doi:10.4103/1817-1737.74270 - Pubmed
-
5. Martinez F, Karlinsky J, Gale M, Jung-Legg Y, Benditt J. Intrathoracic Lymphadenopathy. A Rare Manifestation of Rheumatoid Pulmonary Disease. Chest. 1990;97(4):1010-2. doi:10.1378/chest.97.4.1010 - Pubmed
-
6. David M. Hansell, David A. Lynch, H. Page McAdams et al. Imaging of Diseases of the Chest. (2010) ISBN: 9780723434962 - Google Books
-
7. Chabbert V, Canevet G, Baixas C et al. Mediastinal Lymphadenopathy in Congestive Heart Failure: A Sequential CT Evaluation with Clinical and Echocardiographic Correlations. Eur Radiol. 2004;14(5):881-9. doi:10.1007/s00330-003-2168-1 - Pubmed
-
8. Ngom A, Dumont P, Diot P, Lemarié E. Benign Mediastinal Lymphadenopathy in Congestive Heart Failure. Chest. 2001;119(2):653-6. doi:10.1378/chest.119.2.653 - Pubmed
-
9. Munden R, Carter B, Chiles C et al. Managing Incidental Findings on Thoracic CT: Mediastinal and Cardiovascular Findings. A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2018;15(8):1087-96. doi:10.1016/j.jacr.2018.04.029 - Pubmed
-
10. Bhalla M, Silver R, Shepard J, McLoud T. Chest CT in Patients with Scleroderma: Prevalence of Asymptomatic Esophageal Dilatation and Mediastinal Lymphadenopathy. AJR Am J Roentgenol. 1993;161(2):269-72. doi:10.2214/ajr.161.2.8333359 - Pubmed
-
11. Farrokh D, Abbasi B, Fallah-Rastegar Y, Mirfeizi Z. The Extrapulmonary Manifestations of Systemic Sclerosis on Chest High Resolution Computed Tomography. Tanaffos. 2015;14(3):193-200. PMC4745188 - Pubmed
-
12. Nin C, de Souza V, do Amaral R et al. Thoracic Lymphadenopathy in Benign Diseases: A State of the Art Review. Respir Med. 2016;112:10-7. doi:10.1016/j.rmed.2016.01.021 - Pubmed
-
13. Sampson C & Hansell D. The Prevalence of Enlarged Mediastinal Lymph Nodes in Asbestos-Exposed Individuals: A CT Study. Clin Radiol. 1992;45(5):340-2. doi:10.1016/s0009-9260(05)80089-3 - Pubmed
-
14. Kirchner J, Kirchner E, Goltz J, Lorenz V, Kickuth R. Prevalence of Enlarged Mediastinal Lymph Nodes in Heavy Smokers--A Comparative Study. Eur Radiol. 2011;21(8):1594-9. doi:10.1007/s00330-011-2111-9 - Pubmed
-
15. Pathak V, Adhikari N, Conklin C. Management of Isolated Thoracic Lymphadenopathy of Unclear Etiology: A Survey of Physicians and Literature Review. Cureus. 2023;15(7):e41867. doi:10.7759/cureus.41867 - Pubmed
Promoted articles (advertising)
Unable to process the form. Check for errors and try again.