Mediastinal lymph node necrosis: a newly recognized complication of mediastinoscopy

Eight cases of partial mediastinal lymph node necrosis identified at thoracotomy two to 17 days after cervical mediastinoscopy are described. In 6 cases, the involved nodes were grossly abnormal at operation, requiring frozen section interpretation. In the first 2 patients, the areas of nodal infarction were misinterpreted as necrotic tumor. Permanent sections from all 8 patients showed no evidence of tumor in the infarcted nodes. Factors predisposing to nodal infarction included right-sided tumor, central tumor, and large mediastinoscopic biopsy specimens. In all instances, the infarcted nodes were subcarinal and/or main bronchial. In 2 patients, left recurrent laryngeal nerve palsy occurred after mediastinoscopy. Necrosis in distal nodal areas should be recognized as a complication of thorough mediastinoscopic sampling, presumably due to interruption of arteries supplying these nodes. Awareness of this phenomenon by surgeons and pathologists may avert falsely positive gross or microscopic diagnoses of metastatic malignancy at thoracotomy.