ORIGINAL ARTICLE PURPOSE Anthracosis often results in mediastinal nodal enlargement. The aim of this comparative study was to evaluate if it is possible to differentiate endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) proven anthracotic lymph nodes from malignant lymph node enlargement by means of multislice computed tomography (MSCT). METHODSWe compared the MSCT findings of 89 enlarged lymph nodes due to anthracosis with 54 malignant lymph nodes (non-small cell lung cancer 75.9%, small cell lung cancer 18.5%, and non-Hodgkin lymphoma 5.6%). The lymph nodes were assessed for density (calcification, fat, and necrosis), shape (oval, round), contrast enhancement, and contour (sharp, ill-defined). RESULTSMalignant lymph nodes showed significantly greater axis diameters (P < 0.001). Both anthracotic and malignant nodes were most often oval (86.5% of all malignant nodes vs. 81.5% of all anthracotic nodes, P = 0.420) and showed confluence in a remarkable percentage (28.1% vs. 42.6%, P = 0.075). Anthracotic nodes showed calcifications more often (18% vs. 0%, P < 0.001). Malignant lymph nodes showed a significantly greater short and long axis diameter (P < 0.001), and they had a higher frequency of ill-defined contours (27.8% vs. 2.2%, P < 0.001) and contrast enhancement (27.8% vs. 5.6%, P < 0.001). Nodal necrosis, which appeared in one third of the malignant nodes, was not observed in anthracosis (35.2% vs. 0%, P < 0.001). Confluence of enlarged lymph nodes was seen in malignant lymph nodes (42.6%), as well as in lymph node enlargement due to anthracosis (28.1%, P = 0.075). CONCLUSIONOur results show that there are significant differences in MSCT findings of malignant enlarged lymph nodes and benign lymph node enlargement due to anthracosis.

Purpose: We demonstrate the multislice computed tomography (MSCT) findings of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)-proven hilar and mediastinal lymph node enlargement with signs of anthracosis. Materials and Methods: 53 enlarged lymph nodes in 39 patients (28 male, 11 female) with EBUS-TBNA-confirmed anthracosis were analyzed retrospectively. Results: The mean short axis diameter of the enlarged lymph nodes with signs of anthracosis was 13.7?mm. Lymph nodes most often showed an oval shape (84?%) and were well defined in 66?% of cases. Lymph node confluence was observed in 32?% of cases. Calcifications were documented in 24.5?% of cases. Contrast enhancement and fatty involution were seen seldom (3.8?%). Lymph node necrosis was not seen. Conclusion: Lymph node anthracosis may be found most often in enlarged, well defined lymph nodes with an oval shape, frequently associated with confluence and calcifications. Citation Format: ??Kirchner J, Mueller P, Broll M et?al. Chest CT Findings in EBUS-TBNA-Proven Anthracosis in Enlarged Mediastinal Lymph Nodes. Fortschr R?ntgenstr 2014; 186: 1122???1126

Objectives: Aim of this comparative study was to assess the accuracy of computed tomography (CT) and endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal lymph node staging in cases of lymph node enlargement due to anthracosis and other benign conditions. Methods:In a retrospective analysis we report on the MSCT findings of 39 patients (28 males, 11 females) with EBUS-TBNA confirmed diagnosis of 53 enlarged lymph nodes due to anthracosis. A control group comprised 20 consecutive patients with 27 enlarged lymph nodes (11 males, 9 females) due to chronic lymphadenopathy (n = 14) or sarcoidosis (n = 13).Results: No significant differences were observed between the two groups regarding size (mean short axis diameter 13.7mm vs. 14.5mm), shape (most often oval) or presence of lymph node confluence (32.1% vs. 33.3%), contrast enhancement (3.8% vs. 3.7%), and fatty involution (3.8% vs. 3.7%). In comparison with the control group anthracotic lymph nodes were significantly less often ill-defined in EBUS (5.7 vs. 25.9, p = 0.025) as well as in CT (1.9% vs. 18.5%, p = 0.01), but more often showed calcifications in CT (24.5% vs. 3.7%, p = 0.017). Lymph node colliquation was seen neither in anthracosis nor in other benign conditions. Conclusions:Mediastinal lymph node enlargement due to anthracosis, lymphadenopathy and sarcoidosis show some different findings in EBUS and CT but cannot definitely be differentiated. Advances in knowledge:Radiologists should be aware of mediastinal lymph node enlargement due to anthracosis.

Objectives: To demonstrate the computed tomography findings of endobronchial ultrasound-guided transbronchial needle aspiration-proven hilar and mediastinal lymph node anthracosis. Methods: We retrospectively studied the computed tomography (multislice computed tomography, 64 x 0.75 mm slice collimation, tube voltage 120 kV) findings in 49 patients (37 males, 12 females) with endobronchial ultrasound-guided transbronchial needle aspiration-confirmed diagnosis of 89 anthracotic lymph nodes. Results: Overall, 58.4% of the cytologically proven anthracotic lymph nodes showed enlargement with a mean short axis diameter of 11.1 mm (range, 5-23 mm). The majority of the anthracotic lymph nodes were oval (86.5%), 7.9% were round, and 5.6% were polycyclic in shape. Confluence of anthracotic lymph nodes was seen in 28.1% of the lymph nodes, and patchy hyperdensities-like calcifications were observed in only 18.0%; none of the lymph nodes showed necrosis. Conclusion: Lymph node anthracosis often results in enlargement of hilar and mediastinal lymph nodes.