Mediastinal Lymphadenopathy in Patients Undergoing Cardiac Transplant Evaluation

Abstract

Mediastinal lymphadenopathy (MLA) is not commonly recognized as associated with congestive heart failure (CHF). However, recent case series have reported a 35% to 81% incidence of MLA in different patient populations with CHF. [1][2][3][4] However, the true incidence remains unknown as these reports analyzed different heart failure populations.The lymphatic circulation is primarily responsible for regulating pulmonary fl uid homeostasis. The lymphatic system is highly recruitable and, with time to adapt, can increase clearance of pulmonary edema fl uid by . 10-fold. This system enables low-pressure drainage of excessive fl uid from the interstitium through lymph nodes (LNs) and into collecting ducts. Lymphatic Abbreviations: CHF 5 congestive heart failure; CO 5 cardiac output; EBUS 5 endobronchial ultrasound; EF 5 ejection fraction; EUS 5 endoscopic ultrasound; HT 5 heart transplantation; LN 5 lymph node; MLA 5 mediastinal lymphadenopathy; MPAP 5 mean pulmonary artery pressure; MR 5 mitral regurgitation; MUGA 5 multigated acquisition scan; PCWP 5 pulmonary capillary wedge pressure; RAP 5 right atrial pressure; RVG 5 radionuclide ventriculography; TR 5 tricuspid regurgitation

Mediastinal Lymphadenopathy, Class-Switched Auto-Antibodies and Myocardial Immune-Complexes During Heart Failure in Rodents and Humans

“…Evidence is accumulating that T and B cells are also activated within a week post-MI (Kaya et al, 2012). Importantly, as described previously (Slanetz et al, 1998;Pastis et al, 2011), mediastinal lymphadenopathy is a common finding in patients with heart failure due to ischemic heart disease ( Figure 1A). To further investigate if this phenomenon is indicative of the activation of the adaptive immune system in CHF, myocardial infarction was induced in male Sprague Dawley rats by surgical ligation of the left anterior descending (LAD) coronary artery.…”

“…However, besides rare cases of clinically obvious extreme manifestations, persistent subclinical auto-reactivity can cause ongoing damage to previously healthy myocardial tissue, which may increase the risk of adverse remodeling and heart failure. Notably, enlargement of the mediastinal lymph nodes draining the heart has been observed during heart failure, but was explained by hemodynamic mechanisms related to cardiac decompensation (Ngom et al, 2001;Pastis et al, 2011). Activated B cells generate tissue-specific auto-antibodies and pro-inflammatory cytokines, which can directly contribute to cardiac dysfunction.…”

A study of patients with isolated mediastinal and hilar lymphadenopathy undergoing EBUS-TBNA

“… 17 Mediastinal lymph node enlargement has been reported to be present in half of the patients with chronic obstructive pulmonary disease in one series, irrespective of the degree of airflow obstruction, 6 and between 35% and 66% in patients with severe chronic cardiac failure, 11–13 15 16 where lymphadenopathy may be secondary to raised left atrial filling pressures resulting in increased lymphatic fluid. 12 18–20 …”

The role of endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal processes other than lung cancer

“…For instance, in the case of congestive heart failure (CHF), acute and chronic CHF are known to cause mediastinal lymphadenopathy. In cases where the lymphadenopathy may not resolve with routine treatment of CHF, such as endstage cardiomyopathies being evaluated for transplantation, ruling out infection or malignancy prior to transplant is of the utmost importance, and EBUS should be considered in these cases [45,46].…”