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Location, size, and distribution of mediastinal lymph node enlargement in chronic congestive heart failure
William K Erly1, Rebecca J Borders, Eric K Outwater
1Department of Radiology, College of Medicine, The University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724-5067, USA. klarka@radiology.arizona.edu
Insights
Enlarged mediastinal lymph nodes are common in chronic heart failure patients with low ejection fraction. This lymphadenopathy did not correlate with pulmonary edema on CT scans.
Area of Science:
- Cardiology
- Radiology
- Pulmonology
Background:
- Chronic congestive heart failure is associated with various physiological changes.
- Mediastinal lymph node size and prevalence in heart failure patients require further investigation.
Purpose of the Study:
- To determine the prevalence, location, and size of enlarged mediastinal lymph nodes in patients with chronic congestive heart failure.
- To correlate lymph node enlargement with cardiac ejection fraction.
Main Methods:
- Retrospective analysis of 44 patients who underwent thoracic CT scans prior to cardiac transplantation.
- Independent review of CT images by 3 radiologists for lymphadenopathy (>1 cm short axis).
- Assessment of cardiac ejection fraction using multigated acquisition (MUGA) scans in 38 patients.
Main Results:
- 66% of patients had enlarged mediastinal lymph nodes (>1 cm).
- Patients with lymph node enlargement had significantly lower ejection fractions (20% vs. 35%; P < 0.01).
- 81% of patients with ejection fraction <35% exhibited lymphadenopathy; none with ejection fraction >35% did. Enlarged nodes were predominantly pretracheal.
Conclusions:
- Enlarged mediastinal lymph nodes are prevalent in patients with reduced ejection fraction due to chronic congestive heart failure.
- Lymphadenopathy in this cohort is strongly associated with decreased cardiac function, not pulmonary edema.
Purpose:
The purpose of this study is to identify the prevalence, location, and size of enlarged mediastinal lymph nodes in patients with chronic congestive heart failure and to correlate the presence of lymph node enlargement with cardiac ejection fraction.
Methods:
Sixty-six consecutive, retrospectively identified patients underwent computer tomography (CT) imaging of the thorax as part of a routine work-up prior to cardiac transplantation from 1993 to 1996. CT images of 44 of these patients were independently examined by 3 radiologists for evidence of pulmonary edema, pleural effusions, and the presence, size, and location of lymph nodes >1 cm in short axis. Multigated acquisition (MUGA) scans were available for cardiac ejection fraction assessment in 38 of the 44 patients.
Results:
Twenty-nine (66%) patients had at least 1 mediastinal lymph node >1 cm. The mean ejection fraction was significantly less for patients with lymph node enlargement when compared with patients without lymph node enlargement (20% versus 35%; P < 0.01). Adenopathy was observed in 81% of patients with a calculated ejection fraction of <35%. No patient with an ejection fraction of >35% had lymph node enlargement. There was no correlation between pulmonary edema and the frequency of lymph node appearance. Sixty-three percent of the enlarged nodes were pretracheal, with a mean short axis diameter for all the enlarged nodes of 1.3 cm.
Conclusions:
Enlarged mediastinal lymph nodes were observed in 81% of patients with a calculated ejection fraction of <35%, most commonly in the pretracheal group. The presence of the lymph nodes did not correlate with CT evidence of pulmonary edema.