A 70-Year-Old Man With Large Cervical and Mediastinal Lymphadenopathies

Abstract

We present a case of a 70-year-old man with enlarged mediastinal and cervical lymph nodes that provided interesting radiologic and pathologic observations. The 70-year-old black man was found to have enlarged mediastinal lymph nodes. He had symptoms of atypical chest pain and generalized weakness for 2 weeks prior to the diagnosis. He denied shortness of breath, fever, chills, or night sweats. He was treated for hypertension and onychomycosis.Basic laboratory fi ndings were within normal limits. Pulmonary function tests at the time of presentation showed FEV 1 , FVC, and FEV 1 /FVC ratio of 123% predicted, 133% predicted, and 0.7, respectively. Meanwhile, total lung capacity and carbon monoxide diff using capacity were 103% and 107% predicted, respectively. Two weeks before he presented to our institution, the patient underwent bronchoscopy with transbronchial biopsies of the right lower lobe and endobronchial ultrasound-guided transbronchial needle aspiration of the right hilar lymph nodes.CHEST 2015; 148 ( 1 ) Th e patient's clinical examination was unremarkable except for a palpable right cervical lymph node of 3 cm in diameter with rubbery consistency. His lung examination was within normal limits.Chest radiography showed a soft tissue prominence in the right suprahilar and subcarinal regions. CT scan of the chest revealed multiple enlarged homogeneous lymph nodes with fi ne stippled calcifi cations in the paratracheal, subcarinal, and right hilar regions, the largest being 3.5 cm in diameter ( Fig 1 ). Tracheal dimensions and the appearance of the wall were normal ( Fig 1F ).Interferon-g release assay was positive; meanwhile, HIV enzyme-linked immunosorbent assay, histoplasma antigen, coccidioides antibody, syphilis IgG, and cryptococcal antigen were negative. Our initial diff erential diagnosis included sarcoidosis; TB or nontuberculous mycobacterial infection; lung, head, neck, or germinal cell cancer; lymphoma; histoplasmosis; and coccidioidomycosis.Tissue slides from both bronchoscopy and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), performed at an outside institution, were reviewed carefully. A biopsy specimen consisted of fi ve fragments of alveolated lung parenchyma, which were unremarkable, and three fragments of bronchial wall, which showed patchy, mild, nonspecifi c chronic infl ammation. A lymph node specimen did not show malignant cells. Gram and acid-fast bacillus stains and bacterial and mycobacterial cultures of the BAL specimen were negative.

Amyloidosis of the respiratory system: 16 patients with amyloidosis initially diagnosedante mortemby pulmonologists

“…Mediastinal lymph node amyloidosis, which was diagnosed by EBUS-TBNA in two of our patients, was localised amyloidosis in one patient and systemic AL amyloidosis in the other two patients. There are several case reports of mediastinal lymph node amyloidosis diagnosed by EBUS-TBNA [39,40]. Mediastinal lymphadenopathy is often associated with parenchymal lung disorder.…”

Primary Laryngo-Tracheobronchial Amyloidosis: A Case Report and Literature Review

“…There are two major types of amyloidosis: primary and secondary. Primary amyloidosis most commonly affects the respiratory system [3] Respiratory amyloidosis has been described in three forms: diffuse interstitial, nodular parenchymal, and tracheobronchial [4]. Amyloidosis occurring in the respiratory system may involve the larynx, trachea, bronchus, lung, and mediastinal lymph nodes.…”