J Korean Soc Radiol.  2016 Apr;74(4):215-221. 10.3348/jksr.2016.74.4.215.

Mediastinal Lymph Node Enlargement in Patients with Valvular Heart Disease: CT Evaluation and Clinical Correlation

• Park HJ
• Jung JI
• Ahn MI
• Han DH
• Park SH

• KMID: 2208777
• DOI: http://doi.org/10.3348/jksr.2016.74.4.215

Abstract

PURPOSE
To evaluate the presence, size and location of enlarged mediastinal lymph nodes (LNs) in patients with valvular heart disease (VHD) using computed tomography scans in correlation with ejection fraction (EF).
MATERIALS AND METHODS
We retrospectively evaluated 30 patients with VHD, without pre-existing diseases that could cause lymphadenopathy (LAP). The presence, size, and location of LNs greater than 1 cm in short axis diameter were evaluated. The location of mediastinal LNs was recorded according to the International Association for the Study of Lung Cancer. Furthermore, we evaluated the presence of pulmonary edema, pleural effusion, and other thoracic abnormalities and evaluated EF of the heart on transthoracic echocardiography.
RESULTS
Sixteen patients (53%) had at least 1 enlarged mediastinal LN. The most frequent locations were lower paratracheal (4R, n = 8/4L, n = 6), subcarinal (7, n = 5) and right upper paratracheal (2R, n = 4) regions. The frequency of mediastinal LAP was higher in patients with aortic regurgitation (2 of 2, 100%) followed by mitral regurgitation (8 of 11, 73%); it was also high in patients with pulmonary edema (80%), pleural effusion (81%), or both (77%), as compared to patients without pulmonary edema or pleural effusion (17%) (p = 0.001). Ten of 30 patients showed an abnormal EF of < 55%; among them, 8 had mediastinal LAP. However, the relationship between EF and LAP was not statistically significant (p = 0.058).
CONCLUSION
Mediastinal LN enlargement is common in patients with VHD, especially in cases of pulmonary edema and pleural effusion. Enlarged mediastinal LNs were frequently observed with abnormal EF, however, the relationship between EF and mediastinal LAP was not statistically significant.

MeSH Terms

Aortic Valve Insufficiency
Axis, Cervical Vertebra
Echocardiography
Heart
Heart Valve Diseases*
Humans
Lung Neoplasms
Lymph Nodes*
Lymphatic Diseases
Mediastinum
Mitral Valve Insufficiency
Multidetector Computed Tomography
Pleural Effusion
Preexisting Condition Coverage
Pulmonary Edema
Retrospective Studies

Figure

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  Fig. 1 A 77-year-old man with mitral regurgitation. Unenhanced axial CT scan with mediastinal-window setting shows an enlarged right upper paratracheal lymph node (2R, arrow). Left pleural effusion is also present.

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  Fig. 2 A 76-year-old man with aortic stenosis. A, B. Unenhanced axial CT scans with mediastinal-window setting show enlarged right hilar (10R, arrow in A) and subcarinal (7, arrow in B) lymph nodes. A small amount of bilateral pleural effusions are also present. C. Axial CT scan with lung-window setting shows interlobular septal thickening and increased pulmonary vessels diameter, which are findings of pulmonary edema.

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