In 2016, the patient developed palpable cervical lymphadenopathy. Subsequent PET/CT scans showed no evidence of disease. Her lymphoma initially had been diagnosed in 2012 and had been treated with radiation therapy. We offer the following case to challenge conventional dogma about lymphadenopathy in clinical practice.Ī 55-year-old woman with a history of follicle-center lymphoma of the head and neck, cutaneous granulomas, and suspected asthma was referred to our center after abnormal results of a positron emission tomography (PET)/CT scan. One of the best ways to learn is by reviewing actual cases that are not discussed in textbooks or online references. Severe airway wall thickening on chest CT, presumably from longstanding chronic bronchitis or even bronchiectasis, was significantly associated with lymphadenopathy in 64% of cases. These findings did not differ significantly. Enlarged lymph nodes were present in 49% of patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 COPD, 46% of those with GOLD stage 2 COPD, 58% with GOLD stage 3 COPD, and 50% of those with GOLD stage 4 COPD. Lymph node enlargement was seen more often in the mediastinum (48%) than in the hilar region (20%). In a retrospective study, 4 89 COPD patients were found to have mediastinal and hilar lymphadenopathy in the absence of malignancy and pneumonia 49% of patients showed enlarged lymph nodes. In the absence of other recognized causes of lymphadenopathy in these patients, these findings confirm reactive mediastinal lymph node enlargement in bronchiectasis. 3 Nodes larger than 10 mm (the maximum size for normal nodes) were detected in 29% of patients. Reactive lymphadenopathy was detected on chest CT in 81% of 42 patients with bronchiectasis in one study. The diagnostic approach to such lymphadenopathy should be guided by the radiologic regression seen on follow-up CT scanning after treatment for decompensated CHF. In one report, lymph node histopathology obtained by mediastinoscopy consistently revealed noninflammatory, benign lesions that did not affect the node structure. 2 Chest CT scans have confirmed multiple enlarged lymph nodes exceeding 10 mm-and their disappearance after treatment with diuretics and digitalis. Cases of benign, reactive mediastinal lymphadenopathy have been uncovered on chest radiographs in patients with CHF. It is a pitfall to forget that a number of very common diseases can cause benign, “reactive” lymphadenopathy, including COPD, bronchiectasis, and congestive heart failure (CHF). The drugs linked to lymphadenopathy, pseudolymphoma, or drug-induced hypersensitivity syndrome are legion Table 2 offers a very short list of commonly used prescription and nonprescription drugs. Lymphoma is the clear link between the 2 acronyms. This acronym should be used with another mnemonic, the 5 T’s that cause superior and anterior mediastinal masses: (1) intrathoracic thyroid goiter (2) tumors of the thymus, including thymoma (especially in cases of myasthenia gravis), thymic cyst, thymic carcinoma, and thymic carcinoid (3) dilated thoracic aorta (4) teratoma (mediastinal germ cell tumors) and (5) terrible lymphoma. We offer our mnemonic, MAGIC, to help keep the differential diagnosis of lymphadenopathy in mind during the initial assessment ( Table 1). It is important to know which disease states or conditions lymphadenopathy can be associated with. However, it is a major pitfall to reach conclusions prematurely, even if the patient has preexisting risk factors, such as age, chronic obstructive pulmonary disease (COPD), tobacco smoking, or a history of cancer. 1 Malignancy, particularly lymphoma, is immediately suspected whether the patient is young or old, but it should be the top concern in patients who are older than 50 years. Lymphadenopathy (localized or widespread) that is found during routine physical examination, on chest radiographs, or on chest computed tomography (CT) scans, is a nonspecific finding, but it can elicit intense fear and anxiety from both the patient and the clinician. Solbes E, Harper RW, Louie S. The fear of lymphadenopathy: Does it portend sarcoidosis or lymphoma? Consultant.

Hilar lymph nodes