Mediastinal lymphadenopathy

Cytotoxic chemotherapy is the treatment of choice for chemotherapy-sensitive tumors such as SCLC and lymphoma. As indicated earlier, chemotherapy also may be combined with radiotherapy, especially in patients with lymphoma who have bulky mediastinal lymphadenopathy. 

Diagnosis Clinical diagnosis. Physical findings are usually non-specific. Chest X-ray may reveal a pneumonic process, mediastinal lymphadenopathy or plural effusion. Routine culture is possible but difficult. The diagnosis can be established retrospectively by serology. As for treatment, administration of antibiotics such as streptomycin or gentamicin with early treatment can be very effective. 

A stepwise procedure is used when calculating a dose for an individual patient. First, the limits of the initial tumor and mediastinal lymphadenopathy involved are outlined on chest films taking into account radiologic, bronchoscopic, and clinical information. Second, the target volume is drawn on simulator films. Third, safety margins of the anterior and posterior and lateral or oblique fields are measured (the distance between the target volume and the border of the fields). 

Multiple sclerosis Preganglionic Spinal birth injury Tuberculosis Pancoast tumor Aortic aneurysm Enlarged mediastinal glands Enlargement of thyroid Lymphadenopathy Thoracic neuroblastoma Pulmonary mucormycosis Trauma... 

Chest x-ray may reveal widened mediastinum and pleural effusions. Chest CT may reveal mediastinal lymphadenopathy. 

The chest can be involved in sarcoidosis in many ways, and because of the multitude of potentially different findings, sarcoidosis can be regarded as one of the great mimickers in thoracic radiology. The most common intrathoracic manifestation of sarcoidosis is the presence of mediastinal lymphadenopathy with usually bilateral and rather symmetric involvement of hilar lymph nodes. They can calcify in chronic disease... 

Fig. 26.13. A 27-year-old woman with chronic sarcoidosis. Coronal CT image displays extensive mediastinal lymphadenopathy. Lymph nodes show punctuate calcifications...

Pneumoconiosis may simulate the appearance of sarcoidosis, but is usually easdy diagnosed when correlated with clinical history. Primary tuberculosis, lymphoma, and mediastinal metastases from other tumors usually present with asymmetrical nodal enlargement as opposed to the bihilar, and often-symmetric hilar lymphadenopathy in stage I sarcoidosis. 

In immuno-compromised hosts a peribronchial distribution (resulting in a tree-in-bud sign) of small, sometimes cavitated ill-defined nodules can be obtained due to miliar distribution (Goo and Im 2002 Van Dyck et al. 2003). Ganghopulmonary (primary) forms, however, present with In homogenous consohdation and necrotic mediastinal/hilar lymphadenopathy (Van Dyck et al. 2003). 

Table 2 (2,13,14) (Hgs. 2 and 3). Ground glass opacities (GGO) may be present in UIP, but are nevCT the dominant feature (2,13). Extensive GGO suggest an alternative diagnosis [e.g., DIP, NSIP, or hypersensitivity pneumonitis (HP)] (13). Honeycomb change (HC) is often a prominent feature in UIP, but is uncommon in other HPs (2,9,14). Zones of emphysema (typically in the upper lobes) may be present in smokers (15,16). Mediastinal lymphadenopathy occurs in 55% to 71% of patients with UIP, but is nonspecific (17-19).

Eranquet T, Gimenez A, Alegret X, et al. Mediastinal lymphadenopathy in cryptogenic fibrosing alveohtis the effect of steroid therapy on the prevalence of nodal enlargement. Clin Radiol 1998 53(6) 435-A38. 

Woodring JH, Howard RS U, Johnson MV. Massive low-attenuation mediastinal, retroperitoneal, and pelvic lymphadenopathy on CT from lymphangioleiomyomatosis. Case report. Clin Imaging 1994 18(1) 7-11. 

Wiersema MJ, Vazquez-Sequeiros E, Wiersema LM. Evaluation of mediastinal lymphadenopathy with endoscopic US-guided fine-needle aspiration biopsy. Radiology 2001 219(l) 252-257. 

Classical chest radiograph manifestations of CBD include bilateral middle to upper lobe predominant reticulonodular infiltrate, with or without mild hilar/ mediastinal lymphadenopathy. (Fig. 1). The interstitial opacities are typically characterized as small p or q in the International Labour Organization (ILO)... 

Figure 1 Chest radiograph manifestations of CBD include bilateral middle to upper lobe predominant reticulonodular infiltrate, with or without mild hilar/mediastinal lymphadenopathy.

Mediastinal lymphadenopathy is frequently seen in patients with UIP, NSIP, and other IIPs (106-108). Presumably, this lymph enlargement is due to cytokines released by infiltrating parenchymal mononuclear cells, evoking the expansion and recruitment of dendritic cells (DC) and other antigen-presenting cells (APC) to local lymphoid tissue (i.e., hyperplastic reaction to a chronic inflammatory process) (107,109). The lymph node enlargement (LNE) noticed in both NSIP and UIP makes another case for persistent inflammation (e.g., NSIP) leading to fibrosis (e.g., UIP). 

Jung JI, Kim HH, Jung YJ, et al. Mediastinal lymphadenopathy in pulmonary fibrosis correlation with disease severity. J Comput Assist Tomogr 2000 24(5) 706-710. 

Niimi H, Kang EY, Kwong JS, et al. CT of chronic infiltrative lung disease prevalence of mediastinal lymphadenopathy. J Comput Assist Tomogr 1996 20(2) 305-308. 

CT scan reveals solid lesions that are usually located in the subpleural areas (75,76). Concomitant hilar, mediastinal, or paraesophageal lymphadenopathy can occur, and its presence does not exclude the diagnosis of a benign process. Pleural effusions and lymphadenopathy are rare, and if detected, should raise the possibility of lymphoma. 

Upper airway obstruction Epiglottitis and laryngitis Cricoar5ftenoid arthritis Bronchiectasis Bronchiolitis obliterans Shrinking lung syndrome Diaphragmatic dysfunction Pulmonary vascular disease Thromboembolic disease Pulmonary arterial hypertension Mediastinal and axillary lymphadenopathy... 

Beryllium exposure occurs in a wide variety of occupations. It may cause acute berylliosis (currently very rare), beryllium sensitization, chronic beryllium disease, or lung cancer. Imaging manifestations of chronic beryllium disease are generally similar to those of sarcoidosis, with nodules, ground glass abnormality, septal thickening, conglomerate masses, and mediastinal or hilar lymphadenopathy. 

Common radiographic findings of PTLD consist of single or multiple pulmonary nodules, hilar or mediastinal lymphadenopathy, pleural or pericardial effusions, and parenchymal consolidation... 

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