Most common causes of mediastinal lymphadenopathy

What are the most common causes of mediastinal lymphadenopathy?

The four most common causes of radiographically detectable mediastinal lymphadenopathy are

  • Sarcoidosis
  • Lymphoma
  • Metastatic tumor
  • Granulomatous infections

In younger patients with bilateral hilar and mediastinal lymphadenopathy, sarcoidosis should be the diagnosis of exclusion because it is the most common cause.

These include

  • Primary tuberculosis
  • Histoplasmosis
  • Cryptococcosis
  • Coccidioidomycosis

Mediastinal lymphadenopathy is secondary to various benign and malignant etiologies.

In older individuals, lymphoma and metastatic tumor are the most common causes of mediastinal lymphadenopathy.

It would seem logical that any pulmonary infection could lead to mediastinal lymphadenopathy; however, only granulomatous infections commonly cause mediastinal or hilar lymphadenopathy.

There is a variation in the underlying cause in different demographic settings.

The initial clue to the presence of enlarged mediastinal lymph nodes is through thoracic imaging modalities.

Malignancy (Lung cancer, lymphoma, and extrathoracic cancer) and granulomatous conditions (sarcoidosis and tuberculosis) are the most common causes. 

Mediastinal lymphadenopathy refers to the enlargement or swelling of lymph nodes located in the mediastinum, which is the central region of the chest between the lungs. It is a finding that can be detected on imaging studies, such as chest X-rays or computed tomography (CT) scans, and is often an indication of an underlying condition or disease.

Here are some common causes of mediastinal lymphadenopathy:

  1. Infection: Various infections can cause mediastinal lymphadenopathy, including bacterial infections (such as tuberculosis or atypical mycobacterial infections), fungal infections, viral infections (such as human immunodeficiency virus or Epstein-Barr virus), and parasitic infections (such as toxoplasmosis).
  2. Inflammatory conditions: Inflammatory conditions, such as sarcoidosis and autoimmune diseases like systemic lupus erythematosus (SLE), can lead to mediastinal lymphadenopathy.
  3. Malignancies: Mediastinal lymphadenopathy can be associated with various types of cancers, including lymphomas (Hodgkin’s lymphoma or non-Hodgkin’s lymphoma), lung cancer, metastatic cancers from other sites, and mediastinal tumors.
  4. Granulomatous diseases: Certain granulomatous diseases, like tuberculosis, histoplasmosis, and sarcoidosis, can cause enlargement of mediastinal lymph nodes.
  5. Connective tissue disorders: Connective tissue disorders, such as rheumatoid arthritis or systemic lupus erythematosus, can lead to mediastinal lymphadenopathy as part of their systemic involvement.
  6. Lymphoproliferative disorders: Certain lymphoproliferative disorders, including lymphomas and leukemias, can cause enlargement of mediastinal lymph nodes.

Mediastinal lymphadenopathy refers to the enlargement or swelling of lymph nodes in the mediastinum, which is the central area of the chest located between the lungs. Lymph nodes are small, bean-shaped structures that are part of the lymphatic system and play a crucial role in filtering and trapping foreign substances, such as bacteria, viruses, and cancer cells, from the lymph fluid.

Mediastinal lymphadenopathy can occur due to various underlying causes, and its presence may indicate an underlying medical condition that requires further evaluation.

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