Prevalence of enlarged mediastinal lymph nodes in heavy smokers—a comparative study

Abstract

Objective

To evaluate the frequency of enlarged hilar or mediastinal lymph nodes in heavy smokers (more than 10 pack years) compared with non- smokers.

Material and methods

In a prospective study the CT findings of 88 consecutive patients (44 heavy smokers, 44 non- smokers) were analysed. Exclusion criteria were history of thoracic malignancy, sarcoidosis, occupational dust exposure or clinical evidence of pneumonia. Prevalence, size and site of enlarged lymph nodes were assessed by multidetector computed tomography (MDCT) and correlated with the cigarette consumption and the CT- findings of bronchitis and emphysema.

Results

Twenty-three of the 44 heavy smokers (52%) showed enlarged mediastinal lymph nodes. Non- smokers showed enlarged lymph nodes in 9% (4/44). The most common site of enlarged lymph nodes was the regional station 7 according to the ATS mapping (subcarinal). The difference between the frequency of enlarged lymph nodes in heavy smokers and non- smokers was significant (chi- square 19.3, p < 0.0001). Airway wall thickening and emphysema were often associated with an increased number of enlarged nodes.

Conclusion

The present study demonstrates that enlarged mediastinal lymph nodes may occur in a rather high percentage of heavy smokers, especially in those with a MDCT finding of severe bronchitis.

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Correspondence to Johannes Kirchner.

Appendix

Appendix

Definition of the ATS Regions according to [11, 12]

x:

Supraclavicular nodes.

2R:

Right upper paratracheal nodes (right of the midline of the trachea, cranial to the intersection of the caudal margin of the innominate artery with the trachea)

2L:

Left upper paratracheal nodes

4R:

Right lower paratracheal nodes (right of the midline of the trachea, between the cephalic border of the azygos vein and the intersection of the caudal margin of the brachiocephalic artery with the right side of the trachea)

4L:

Left lower paratracheal nodes (nodes to the left of the midline of the trachea, between the top of the aortic arch and the level of the carina, medial to the ligamentum arteriosum)

5:

Aortopulmonary nodes (subaortic and paraaortic nodes lateral to the ligamentum arteriosum or the aorta or left pulmonary artery)

6:

Anterior mediastinal nodes (anterior to the ascending aorta or the innominate artery)

7:

Subcarinal nodes

8:

Paraesophageal nodes (nodes dorsal to the posterior wall of the trachea and to the right or left of the midline of the esophagus)

9:

Right or left pulmonary ligament nodes.

1OR:

Right tracheobronchial nodes (nodes to the right of the midline of the trachea, from the level of the cephalic border of the azygos vein to the origin of the right upper- lobe bronchus)

1OL:

Left peribronchial nodes (nodes to the left of the midline of the trachea, between the carina and the left-upperlobe bronchus, medial to the ligamentum arteriosum)

11:

Intrapulmonary nodes (nodes removed in the right- or left-lung specimen, plus those distal to the main-stem bronchi or secondary carina)

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Kirchner, J., Kirchner, E.M., Goltz, J.P. et al. Prevalence of enlarged mediastinal lymph nodes in heavy smokers—a comparative study. Eur Radiol 21, 1594–1599 (2011). https://doi.org/10.1007/s00330-011-2111-9

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Keywords

  • Tobacco
  • MDCT
  • Lymph node enlargement
  • Comparative study