Se. Kearney et al., The characteristics and significance of thoracic lymphadenopathy in parapneumonic effusion and empyema, BR J RADIOL, 73(870), 2000, pp. 583-587
Citations number
5
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Medical Research Diagnosis & Treatment
The occurrence of significant mediastinal lymphadenopathy together with ple
ural effusion or empyema inevitably raises concern about the presence of in
trathoracic malignancy or granulomatous disease. Lymph node enlargement may
also occur when pneumonia is accompanied by a parapneumonic effusion or em
pyema. Features that allow "benign" lymph node enlargement to be distinguis
hed from malignant causes have not previously been determined. The present
study aims to establish the CT characteristics of enlarged nodes in parapne
umonic effusion. The appearances of mediastinal lymph nodes were recorded i
n 50 consecutive patients with parapneumonic effusion/empyema. 18 (36%) had
mediastinal lymphadenopathy (node size greater than 1 cm). The mean number
of enlarged nodes was 1.9 (range 1-3) and the mean size was 1.4 cm (2 cm m
aximum). Seven patients had a single involved site, nine patients two sites
and two patients three sites. The right paratracheal area was most commonl
y involved and the subcarinal area contained the largest nodes. The presenc
e of enlarged nodes did not correlate with biochemical and microbiological
stage of pleural infection, length of history, or extent of consolidation.
This study shows that mediastinal lymphadenopathy is commonly associated wi
th parapneumonic effusion and that multiple sites may be involved. The degr
ee of enlargement is moderate although lymphadenopathy of greater than 2 cm
size should raise the possibility of other pathology.