title: Extrapleural and cardiophrenic lymph nodes: prevalence, clinical significance and diagnostic value.
abstract: OBJECTIVE
  The aim of this study was to evaluate the prevalence, clinical meaning and diagnostic value of extrapleural and cardiophrenic nodes occasionally observed on computed tomography (CT) scans of the chest.
  
  
  METHODS
  We included 750 consecutive patients who underwent CT of the chest for different clinical purposes (340 nonneoplastic patients, 270 with extrathoracic neoplasms, 120 with intrathoracic neoplasms, 20 with pleural metastasis) and 91 patients with histologically proven malignant pleural mesothelioma (MPM). For each group of patients, we analysed the presence of extrapleural and cardiophrenic nodes, their number (single or multiple) and their size.
  
  
  RESULTS
  The prevalence of cardiophrenic nodes between 6 and 10 mm and >10 mm was significantly higher in patients with MPM (28.6 and 26.4 %, respectively) than in all other categories of patients, except for patients with pleural metastasis (30 and 25 %, respectively). The prevalence of extrapleural nodes, independently from their size, was significantly higher in patients with MPM (68 %) compared with all other groups, including patients with pleural metastasis (5 %; p < 0.0001).
  
  
  CONCLUSIONS
  Cardiophrenic nodes >5 mm and extrapleural nodes of any size have a significant diagnostic value in malignant pleural disease, either primary or secondary, whereas they are extremely rare in other neoplastic or nonneoplastic diseases.
authors.affiliation: Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University, Via dei Vestini, 66013, Chieti, Italy, b.feragalli@unich.it.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Feragalli
authors.forename: Cesare
authors.initials: C
authors.lastname: Mantini
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Civitareale
authors.forename: Roberta
authors.initials: R
authors.lastname: Polverosi
authors.forename: Armando
authors.initials: A
authors.lastname: Tartaro
authors.forename: Antonio Raffaele
authors.initials: AR
authors.lastname: Cotroneo
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008654:Mesothelioma / Q000000981:diagnostic imaging / Q000473:pathology; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D015995:Prevalence; D013902:Radiography, Thoracic; D013899:Thoracic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed