Mediastinal lymphadenopathy

Mediastinal lymph nodes are lymph nodes located in the mediastinum. The mediastinum is the area between the lungs that contains the heart, esophagus, trachea, cardiac nerves, thymus, and lymph nodes in the central chest.

Swollen lymph nodes are called lymphadenopathy.


Mediastinal lymphadenopathy can have many different causes.

The most common reasons include:

  • acute lymphoblastic leukemia
  • Anthrax (“Miner’s Lung”)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • coccidioidomycosis
  • cystic fibrosis
  • Esophageal cancer
  • Histoplasmosis
  • lung cancer
  • lymphoma
  • sarcoidosis
  • tuberculosis

Globally, mediastinal lymphadenopathy is primarily associated with tuberculosis, which has a high infection rate (10 million per year). Mediastinal lymphadenopathy is most commonly associated with lung cancer and COPD in the United States.


If the cause of mediastinal lymphadenopathy is uncertain, your healthcare provider may order a biopsy to examine the tissue under a microscope and determine the cause.

  • This can be obtained with a procedure called mediastinoscopy. This involves a small surgical incision made on or above the breastbone. A fiber-optic instrument called a mediastinoscope is then inserted through the incision and into the middle of the chest to obtain a sample of one or more lymph nodes. The procedure is performed in a hospital under general anesthesia.
  • Sometimes a less invasive procedure, fine needle aspiration (FNA), is performed to obtain a biopsy sample. During this procedure, a long needle is inserted through the chest cavity into the lymph node to extract the cells.
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Biopsy results are usually ready within five to seven days.

investigate cancer

Lymph nodes are small structures found throughout the body. They filter toxins and pathogens.

Mediastinal lymph nodes are often the first places cancer cells from the lungs travel, which is why they can be examined to determine if the cancer is spreading.

When mediastinal lymph nodes enlarge due to malignancy, lung cancer and lymphoma are the two most likely causes.

In some cases, secondary lung cancer can cause enlarged mediastinal lymph nodes when metastatic cancer spreads from another part of the body to the lungs and then to the lymph nodes.

The location and number of lymph nodes involved is an important aspect of cancer staging. This classification system defines how advanced the malignancy is and helps determine which treatments should be given and what outcomes can be expected.

The link between cancer and lymph nodes

Significance of lymphoma

Lymphoma is a cancer of white blood cells called lymphocytes and can be classified as either Hodgkin lymphoma or non-Hodgkin lymphoma. Mediastinal lymphadenopathy is one way to differentiate the two diseases.

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Hodgkin’s Lymphoma vs Non-Hodgkin’s Lymphoma

Mediastinal lymphadenopathy occurs in more than 85% of Hodgkin lymphoma (HL) cases compared to 45% of non-Hodgkin lymphoma (NHL) cases. Furthermore, the pattern of expansion in the HL tends to be orderly and progressive, while the NHL is more diffuse.

Although chest imaging can identify suspicious lymph nodes, a definitive diagnosis can only be made with biopsy.

Frequently Asked Questions

  • What is mediastinal lymphadenopathy?

    Mediastinal lymphadenopathy is enlarged lymph nodes in the chest, especially the mediastinum (the area between the lungs, including the heart, trachea, and esophagus). Swollen mediastinal lymph nodes are a sign of an underlying disease or infection.

  • What are the symptoms of swollen mediastinal lymph nodes?

    Because mediastinal lymph nodes are located in the chest cavity, they are usually only seen on imaging studies. That being said, swollen lymph nodes can sometimes press on structures in the chest, causing coughing, shortness of breath, wheezing, and difficulty swallowing.

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  • What causes swollen mediastinal lymph nodes?

    There are many causes of swollen mediastinal lymph nodes, some involving the lungs and others affecting the entire body. Some of the more common include:

    • acute lymphoblastic leukemia (ALL)
    • cancer metastasis
    • coccidioidomycosis
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Cystic Fibrosis (CF)
    • Esophageal cancer
    • Histoplasmosis
    • Hypersensitivity pneumonitis
    • lung cancer
    • lymphoma
    • sarcoidosis
    • Tuberculosis (TB)
  • How to diagnose mediastinal lymphadenopathy?

    If cancer is suspected, a fiberoptic scope (called a mediastinoscope) can be inserted through the chest wall to view the lymph nodes and take a biopsy. Diagnostic imaging of lymph nodes using computed tomography (CT) and positron emission tomography (PET) can also help differentiate cancer from other diseases.

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  • How is mediastinal lymphadenopathy treated?

    Mediastinal lymphadenopathy itself may not be treatable because it is ultimately the result of an underlying disease or infection. Treating the underlying cause usually resolves the condition. However, in diseases such as non-small cell lung cancer, dissection (resection) of mediastinal lymph nodes is associated with improved survival.

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