The Association of Reactive Mediastinal and Hilar Lymphadenopathies with Congestive Heart Failure
Keywords:
adenopathy, bronchoscopy, CHFAbstract
Background
Isolated mediastinal and hilar lymphadenopathy (MLAD) is a common imaging finding, often leading to tissue sampling to achieve a diagnosis. Patients with congestive heart failure (CHF) are likely to have 'reactive lymphadenopathy' in this setting and therefore not yield an alternative etiology. Our study aimed to identify risk factors in patients with isolated MLAD that may aid in predicting a diagnosis of reactive lymphadenopathy, particularly those with underlying CHF.
Methods
Retrospective review and 12-month follow-up of all patients who underwent EBUS-TBNA bronchoscopy between June 1, 2010 and December 31, 2015 at a single institution.
Results
Of 1733 patients who underwent EBUS-TBNA, 46 had isolated MLAD. The most common diagnoses were reactive lymphadenopathy (23/46 [50%]), granulomatous disease (22/46 [47.8%]), and malignancy (1/46 [2.2%]). Of the 23 patients with reactive lymphadenopathy, 21 had CHF (21/23 [91.3%]). Accordingly, of the 24 patients with CHF, 21 (87%) had reactive lymphadenopathy versus 3 (13%) having an alternative diagnosis (p < 0.01). On a univariate analysis, patients with isolated MLAD and CHF were 70 times more likely to have reactive lymphadenopathy (OR 70 [10.56-463.86], p <0.001). On multivariate analysis, CHF was the only factor predictive of a diagnosis of reactive lymphadenopathy (OR 47.2 [6.68 – 333.59], p < 0.001).
Conclusions
There is a strong association between CHF and a diagnosis of reactive MLAD in the setting of radiographically isolated MLAD. Clinicians should be alert to these associations to balance the known procedural risks of EBUS-TBNA with the benefits of finding an unlikely alternative diagnosis.
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