Mediastinal lymph node enlargement

Last revised by Liz Silverstone on 29 Aug 2023

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 pneumonias, 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, 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 short-axis diameter over 15 mm and if there is no explicable disease 9. Interval size increase on follow up dictates the need for biopsy. 

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