Chest
Original ResearchTransplantationMediastinal Lymphadenopathy in Patients Undergoing Cardiac Transplant Evaluation
Section snippets
Study Design
The population was composed of patients with end-stage cardiomyopathy referred for cardiac transplantation at the Medical University of South Carolina from March 27, 1997, to November 15, 2005. Patients were excluded if they did not have a chest CT scan performed within 3 months of routine cardiac imaging and hemodynamic assessment as part of their transplant evaluation. Chest CT scans were ordered routinely in patients with a ≥ 20 pack-year smoking history and at the request of pulmonary
Results
Over the 8-year study period, we identified 118 cardiac transplant candidates who met our criteria for analysis. The mean age was 51.6 ± 9.5 years. Ninety-five patients (81%) were men, and 85 patients (72%) were white. The overwhelming majority of these patients had either an ischemic or idiopathic cardiomyopathy (Table 1). The mean time between chest CT scan and right-sided heart catheterization was 9 days (± 19 days).
Of the 118 patients studied, 53 (45%) patients had enlarged mediastinal LNs.
Discussion
The important findings of this study include the following: The frequency of MLA was 45% in this population of HT candidates. Of the hemodynamic parameters evaluated, an elevated MPAP, the presence of MR, the presence of TR, an elevated RAP, and an elevated PCWP had weak but significant correlations with mediastinal LN enlargement. In the group of nine patients transplanted with MLA, all nine had regression in the size of the lymphadenopathy after transplant. There were seven HT candidates (two
Acknowledgments
Author contributions: Dr Pastis: contributed to the writing of the study protocol, acquiring data, wrote first draft of manuscript and reviewed all drafts, and has seen and approved the final version.
Dr Van Bakel: contributed to writing of the study protocol, data acquisition, reviewing all drafts of the manuscript, and has seen and approved the final version.
Mr Brand: contributed to writing of the study protocol and manuscript and data acquisition.
Dr Ravenel: contributed to data acquisition,
References (24)
- et al.
The spectrum of pulmonary abnormalities on computed chest tomographic imaging in patients with advanced heart failure
Am J Cardiol
(2000) - et al.
Benign mediastinal lymphadenopathy in congestive heart failure
Chest
(2001) Tumors after renal and cardiac transplantation
Hematol Oncol Clin North Am
(1993)- et al.
Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology
J Am Soc Echocardiogr
(2005) - et al.
American Society of Echocardiography. Recommendations for evaluation of the severity of native valve regurgitation with two-dimensional and Doppler echocardiography
J Am Soc Echocardiogr
(2003) - et al.
Peripheral pulmonary vascular and airway abnormalities in adolescents with rheumatic mitral stenosis
Int J Cardiol
(1988) - et al.
Determinants of pulmonary hypertension in left ventricular dysfunction
J Am Coll Cardiol
(1997) - et al.
The utility of sonographic features during endobronchial ultrasound-guided transbronchial needle aspiration for lymph node staging in patients with lung cancer: a standard endobronchial ultrasound image classification system
Chest
(2010) - et al.
Mediastinal lymphadenopathy in congestive heart failure: a sequential CT evaluation with clinical and echocardiographic correlations
Eur Radiol
(2004) - et al.
Mediastinal lymphadenopathy and hazy mediastinal fat: new CT findings of congestive heart failure
AJR Am J Roentgenol
(1998)
Location, size, and distribution of mediastinal lymph node enlargement in chronic congestive heart failure
J Comput Assist Tomogr
Role of pulmonary lymphatics in chronic pulmonary edema
Circ Res
Cited by (9)
Sarcoidosis diagnosed on granulomas in the explanted heart after transplantation: Results of a French nationwide study
2020, International Journal of CardiologyCitation Excerpt :A large proportion of them did not have histological documentation of mediastinal lymph nodes. Non-caseating granuloma was found in only 1 out of 7 patients who had lymph nodes biopsy [26]. Interestingly, skin, nervous system, and renal involvements were not observed.
Frequency of mediastinal lymphadenopathy in patients with idiopathic pulmonary arterial hypertension
2013, ChestCitation Excerpt :Mean LVEF for patients described in these reports ranged from 20% to 40%, with lymphadenopathy more commonly seen in patients with lower ejection fraction (<35%).1 Enlarged lymph nodes were also found to decrease in size with treatment of underlying heart failure or subsequent heart transplant.4,5,10 The underlying mechanism for MLAD in patients with CHF is believed to be elevated, left-sided filling pressures resulting in increased hydrostatic pressure at the alveolar capillary.
Mediastinal Lymphadenopathy, Class-Switched Auto-Antibodies and Myocardial Immune-Complexes During Heart Failure in Rodents and Humans
2020, Frontiers in Cell and Developmental BiologyCase report: Two men with dyspnea, enlarged lymph nodes · Dx
2016, Journal of Family Practice
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).