Abstract
The aim of this study was to evaluate the frequency and evolution after treatment of mediastinal lymphadenopathy associated with congestive left heart failure on CT scans in correlation with clinical and echocardiographic findings. Thirty-one consecutive patients with subacute left heart failure underwent a clinical evaluation using the NYHA classification, a CT examination, and transthoracic echocardiography at the time of initial presentation (T1). After initiation of medical treatment (T2), follow-up CT scans were systematically obtained together with a clinical evaluation. At T1, all patients showed severe (type III: n=12, 39%; type IV: n=12, 39%) to moderate (type I, n=1, 3%; type II, n=6, 19%) dyspnea with a mean ejection fraction of 39% (range 22–74%). On initial CT scans, enlarged mediastinal lymph nodes were seen in 13 patients (42%) with blurred contours in 5 patients (16%) and hazy mediastinal fat in 1 patient (3%). Significant decrease in the size of lymphadenopathy was observed between T1 and T2 (T1, n=13, 42% vs T2, n=10, 32%; p<0.05) with a concurrent decrease in the severity of dyspnea (grade III–IV dyspnea at T1, n=24, 78% vs grade I–II dyspnea at T2, n=26, 83.5%). Patients with enlarged lymph nodes at T1 showed: (a) a significantly lower ejection fraction at echocardiography than those without lymphadenopathy (mean±SD value: 34±12.9 vs 43±13.8%; p=0.04); (b) a significantly larger diameter of the right superior pulmonary vein (mean±SD value: 17±2.75 vs 14±3.9 mm; p=0.04); and (c) a higher frequency of abnormal peribronchovascular thickening (n=5 vs n=1; p=0.06). Mediastinal lymphadenopathy associated with subacute left heart failure was observed in 13 patients (42%), showing regression after initiation of treatment in 8 of 13 patients (62%).
Similar content being viewed by others
References
Fraser RS, Colman N, Müller NL, Paré PD (1999) Pulmonary edema. In: Diseases of the chest, 4th edn, vol 3. Saunders, Philadelphia, pp 1946–2017
Primack SL, Muller NL, Mayo JR, Remy-Jardin M, Remy J (1994) Pulmonary parenchymal abnormalities of vascular origin: high-resolution CT findings. Radiographics 14:739–746
Slanetz PJ, Trruong M, Shepard JAO, Trotman-Dickerson B, Drucker E, McLoud TC (1998) Mediastinal lymphadenopathy and hazy mediastinal fat: new CT findings of congestive heart failure. AJR 171:1307–1309
Ngom A, Dumont P, Diot P, Lemarié E (2001) Benign mediastinal lymphadenopathy in congestive heart failure. Chest 119:653–656
Partridge A, Nasser S, Dsik S (2000) Nonmalignant diagnoses in patients. Case 1: Mediastinal lymphadenopathy associated with congestive heart failure. J Clin Oncol 18:2635–2636
Miller JA, Contractor S, Maldjian P, Wolansky L (2000) Transient mediastinal enlargement: an unusual computed tomographic manifestation of pulmonary venous hypertension and congestive heart failure. Respiration 67:216–218
Remme WJ, Swedberg K (2001) Guidelines for the diagnosis and treatment of chronic heart failure: task force for the diagnosis and treatment of chronic heart failure. European Society of Cardiology. Eur Heart J 22:2217–2218
Glazer GM, Gross BH, Quint LE, Francis IR, Bookstein FL, Orringer MB (1985) Normal mediastinal lymph nodes: number and size according to American Thoracic Society mapping. AJR 144:261–265
Friedmann BJ, Waters J, Kwan OL, De Maria AN (1985) Comparison of magnetic resonance imaging and echocardiography in determination of cardiac dimensions in normal subjects. J Am Coll Cardiol 5:1369–1376
Leeds SE, Uhley HN, Teleskzky LB (1981) Direct cannulation and injection lymphangiography of the canine cardiac and pulmonary efferent mediastinal lymphatics in experimental congestive heart failure. Invest Radiol 16:193–200
Drake RE, Dhother S, Teague RA, Gabel JC (1997) Lymph flow in sheep with rapid cardiac ventricular pacing. Am J Physiol 272:1595–1598
Aberg H, Morlin C, Fritz G (1981) Captopril-associated lymphadenopathy. Br Med J 283:1297–1298
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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 14, 881–889 (2004). https://doi.org/10.1007/s00330-003-2168-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-003-2168-1