title: Mediastinal lymphadenopathy in congestive heart failure: a sequential CT evaluation with clinical and echocardiographic correlations.
abstract: The aim of this study was to evaluate the frequency and evolution after treatment of mediastinal lymphadenopathy associated with congestive left heart failure on CT scans in correlation with clinical and echocardiographic findings. Thirty-one consecutive patients with subacute left heart failure underwent a clinical evaluation using the NYHA classification, a CT examination, and transthoracic echocardiography at the time of initial presentation (T1). After initiation of medical treatment (T2), follow-up CT scans were systematically obtained together with a clinical evaluation. At T1, all patients showed severe (type III: n=12, 39%; type IV: n=12, 39%) to moderate (type I, n=1, 3%; type II, n=6, 19%) dyspnea with a mean ejection fraction of 39% (range 22-74%). On initial CT scans, enlarged mediastinal lymph nodes were seen in 13 patients (42%) with blurred contours in 5 patients (16%) and hazy mediastinal fat in 1 patient (3%). Significant decrease in the size of lymphadenopathy was observed between T1 and T2 (T1, n=13, 42% vs T2, n=10, 32%; p<0.05) with a concurrent decrease in the severity of dyspnea (grade III-IV dyspnea at T1, n=24, 78% vs grade I-II dyspnea at T2, n=26, 83.5%). Patients with enlarged lymph nodes at T1 showed: (a) a significantly lower ejection fraction at echocardiography than those without lymphadenopathy (mean+/-SD value: 34+/-12.9 vs 43+/-13.8%; p=0.04); (b) a significantly larger diameter of the right superior pulmonary vein (mean+/-SD value: 17+/-2.75 vs 14+/-3.9 mm; p=0.04); and (c) a higher frequency of abnormal peribronchovascular thickening ( n=5 vs n=1; p=0.06). Mediastinal lymphadenopathy associated with subacute left heart failure was observed in 13 patients (42%), showing regression after initiation of treatment in 8 of 13 patients (62%).
authors.affiliation: Department of Radiology, University of Toulouse, Avenue Jean-Poulhes, 31403 Toulouse, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Chabbert
authors.forename: Guillaume
authors.initials: G
authors.lastname: Canevet
authors.forename: Cécile
authors.initials: C
authors.lastname: Baixas
authors.forename: Michel
authors.initials: M
authors.lastname: Galinier
authors.forename: Valérie
authors.initials: V
authors.lastname: Deken
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.forename: Philippe
authors.initials: P
authors.lastname: Otal
authors.forename: Francis
authors.initials: F
authors.lastname: Joffre
authors.forename: Jacques
authors.initials: J
authors.lastname: Remy
authors.forename: Martine
authors.initials: M
authors.lastname: Remy-Jardin
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008206:Lymphatic Diseases / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000000981:diagnostic imaging; D012720:Severity of Illness Index; D012815:Signal Processing, Computer-Assisted; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*