Mediastinal lymphadenopathy in COVID-19: A review of literature

Abstract

A novel coronavirus disease 2019 (COVID-19) is a progressive viral disease that affected people around the world with widespread morbidity and mortality. Patients with COVID-19 infection typically had pulmonary manifestation but can also present with gastrointestinal, cardiac, or neurological system dysfunction. Chest imaging in patients with COVID-19 commonly show bilateral lung involvement with bilateral ground-glass opacity and consolidation. Mediastinal lymphadenopathy can be found due to infectious or non-infectious etiologies. It is commonly found to be associated with malignant diseases, sarcoidosis, and heart failure. Mediastinal lymph node enlargement is not a typical computer tomography of the chest finding of patients with COVID-19 infection. We summarized the literature which suggested or investigated the mediastinal lymph node enlargement in patients with COVID-19 infection. Further studies are needed to better characterize the importance of mediastinal lymphadenopathy in patients with COVID-19 infection.

Can Mediastinal Lymphadenopathy Signal Pericarditis, Pericardial Effusion, and Severe Disease in a COVID-19 Patient?

“…Meta-analysis revealed 3.38% of patients had a presentation of lymphadenopathy on CT scan [1]. The size of the lymph nodes is a strong predictor of etiology with 15 mm or less more likely reactive and larger than 25 mm likely pathologic due to malignancy or sarcoidosis [5]. Since cardiac and pulmonary lymphatic drainage is to the mediastinal lymph nodes, it would be reasonable to assume that these lymph nodes enlargement will be more likely when both organs are involved or if there is a severe disease.…”

Mediastinal lymph node enlargement in COVID-19: Relationships with mortality and CT findings

“…In addition, it has been found that the district where the person lives and smoking history are associated with the occurrence of MLNE. MLNE is not the typical chest CT finding in COVID-19 pneumonia 10 . However, atypical findings such as MLNE are associated with the prognosis of patients with COVID-19 11 .…”

“…The incidence of MLNE in patients with COVID-19 pneumonia is 0%-66%, and the relationship between CT findings has not been demonstrated in the literature yet 10 . The higher mortality rate in hospitalized COVID-19 patients with MLNE than those without MLNE suggested that it should be investigated as a prognostic factor for serious disease 12 .…”

Mediastinal lymphadenopathy and prognosis of COVID-19 disease

“…All CT images were reviewed and evaluated by expert radiologists. The criterion for significant lymph node enlargement of mediastinal lymph nodes was considered a short-axis dimension ≥10 mm ( 22 ). Information of 213 patients was recorded, including demographic characteristics, clinical symptoms, underlying diseases, and laboratory findings.…”

“…Several studies have recently suggested that mediastinal lymphadenopathy (LAP) prevalence in patients with COVID-19 ranges from 3•4% to 5•4%, while its prevalence in patients with severe COVID-19 has been seen a sharp rise to 66% ( 14 , 18 , 19 ). Three retrospective studies in China reported a prevalence of mediastinal lymphadenopathy in 43.5%, 41.7%, and 19.8% of 154, 192, and 499 patients with COVID-19, respectively ( 20 – 22 ). Also, lymphadenopathy at admission was significantly more common in patients who died during hospitalization than those discharged ( 23 ) and was associated with increased mortality ( 24 ).…”