Hilar Node Enlargement Research Articles

Pulmonary Involvement of T-cell type Lymphoma with Rapid, Bilateral Infiltration and High Fever Simulating Pueumonia

The radiologically detectable pulmonary involvement of NHL at diagnosis is about 4%. The commonest intrathoracic manifestations of secondary pulmonary lymphoma are mediastinal or hilar lymph node enlargement And the most frequent manifestations of pulmonary parenchymal lymphoma are lymphomatous nodules. But, when patients with newly diagnosed lymphoma exhibit rapidly progressive parenchymal lesions, an infection, such as pneumonia, is usually suspected. We present a report of a patient who developed rapidly progressive pulmonary involvement with T cell lymphoma, which was considered to be pneumonia because of high fever and rapidly progressive radiologic findings.

Silicosis presenting as bilateral hilar lymphadenopathy.

Classical radiographic features of patients presenting with silicosis are diffuse interstitial shadowing with subsequent enlargement of hilar nodes, sometimes with "eggshell" calcification. Five case histories are described of workers who were exposed to silica and presented initially with bilateral hilar lymphadenopathy without radiographic evidence of interstitial lung disease. One case progressed to show features of silicosis.

Sarcoidlike reaction in patients with malignancy.

To determine the radiologic features, pathogenesis, and prognostic importance of sarcoidlike reaction in patients with malignancy. Radiographs and computed tomographic (CT) scans of the chests of 10 patients with known malignancy and either concurrent or subsequent development of noncaseating granulomas (NCG) were reviewed and correlated with histopathologic reports and pertinent clinical data. Ten patients with malignancy were found to have either mediastinal or hilar lymph node enlargement (n = 4) or parenchymal lung disease (n = 6). The presumptive diagnosis was metastatic disease. In eight of 10 histopathologic specimens, no tumor was found, but innumerable NCGs were present. They were thought to be consistent with sarcoidlike reaction. In the other two specimens, only a small focus of tumor cells was found amidst innumerable NCGs. On CT scans of the chests, parenchymal lung disease took the form of either ground-glass attenuation (n = 1) or nodules following perivascular and peribronchial distributions (n = 5). Lymph node enlargement and parenchymal lung nodules may not indicate metastatic disease. Sampling of all abnormal areas may be helpful in staging the disease and in treating and determining the prognosis of patients. Likewise, the discovery of NCG does not necessarily indicate sarcoidosis and may represent sarcoidlike reaction.

Open quiz solution: Case report 705

In summary, Sarcoidosis is a rare but well-recognized cause of diffuse osteosclerosis. The differential diagnosis of osteosclerosis is limited and includes osteoblastic metastases, sclerotic myeloma, myelofibrosis, and less common infiltrative bone marrow processes such as mastocytosis and sarcoidosis. In all of these entities the sclerosis is found most often in the axial (red marrow) skeleton. In this regard, it is interesting that cases of osseous sarcoid are usually lytic and located in the peripheral skeleton. In patients with osteosclerotic sarcoidosis, the diagnosis may be suggested by a past history of the disease or ancillary signs such as hilar node enlargement and subtle skin involvement. However, the specific diagnosis usually requires bone marrow biopsy with the demonstration of extensive, noncaseating granulomas.

The Radiographic Features of Pulmonary Tuberculosis Observed for the Western Region of Saudi Arabia

The radiographs of 714 patients (486 males, 228 females) with proved pulmonary tuberculosis (PTB) were studied. Most were between 15 and 44 years of age, and most (86.8%) exhibited the usual radiographic appearance of PTB. All had extensive bilateral lung disease, with the right upper lobe the most commonly involved. Parenchymal opacities, cavitation, and atelectasis were common. Many radiographic patterns were encountered, and these varied from one radiograph to the next and even within the same radiograph, with two or more patterns seen together. Unusual radiographic manifestations were found in 13.2% of the patients. These included isolated opacities in the lower lobe, middle lobe, or lingula; normal chest radiographs; isolated pleural effusions; isolated mediastinal or hilar lymphadenopathy, and mass-like lesions. Permanent lung damage could be avoided if the various radiographic features of pulmonary tuberculosis were promptly recognized, thus leading to early treatment.

A Case of Sarcoidosis Associated with Bronchial Asthma.

A 54-year-old woman was treated for bronchial asthma for 14 yr. In March of 1989, chest roentgenography and computed tomography (CT) revealed development of bilateral pulmonary hilar lymph node enlargement. Positive 67Ga uptake was observed in bilateral pulmonary hili. Although levels of serum angiotensin converting enzyme (ACE) and lysozyme were within normal range, biopsy specimen of scalene lymph nodes showed noncaseating epitheloid-cell granuloma, leading to the diagnosis of sarcoidosis. Steroid therapy ameliorated both sarcoidosis and bronchial asthma. Although the association of sarcoidosis and bronchial asthma is uncommon, there may be an etiological relationship between them.

MONO‐OLIGOCLONAL PRODUCTION OF IMMUNOGLOBULINS IN A CHILD WITH THE WISKOTT‐ALDRICH SYNDROME

British Journal of HaematologyVolume 75, Issue 3 p. 436-438 MONO-OLIGOCLONAL PRODUCTION OF IMMUNOGLOBULINS IN A CHILD WITH THE WISKOTT-ALDRICH SYNDROME Jean-Daniel Tissot, Jean-Daniel Tissot Centre de Transfusion Sanguine CRS, Lausanne, SwitzerlandSearch for more papers by this authorPhilippe Schneider, Philippe Schneider Centre de Transfusion Sanguine CRS, Lausanne, SwitzerlandSearch for more papers by this authorBernard Pelet, Bernard Pelet Service de Pédiatrie, Universitaire Vaudois, Lausanne, SwitzerlandSearch for more papers by this authorPhilippe C. Frei, Philippe C. Frei Division d'Immunologie et d'Allergologie du Centre Hospitalier, Universitaire Vaudois, Lausanne, SwitzerlandSearch for more papers by this authorDenis Hochstrasser, Denis Hochstrasser Clinique Médicale, Hôpital Cantonal Universitaire, Genève, SwitzerlandSearch for more papers by this author Jean-Daniel Tissot, Jean-Daniel Tissot Centre de Transfusion Sanguine CRS, Lausanne, SwitzerlandSearch for more papers by this authorPhilippe Schneider, Philippe Schneider Centre de Transfusion Sanguine CRS, Lausanne, SwitzerlandSearch for more papers by this authorBernard Pelet, Bernard Pelet Service de Pédiatrie, Universitaire Vaudois, Lausanne, SwitzerlandSearch for more papers by this authorPhilippe C. Frei, Philippe C. Frei Division d'Immunologie et d'Allergologie du Centre Hospitalier, Universitaire Vaudois, Lausanne, SwitzerlandSearch for more papers by this authorDenis Hochstrasser, Denis Hochstrasser Clinique Médicale, Hôpital Cantonal Universitaire, Genève, SwitzerlandSearch for more papers by this author First published: July 1990 https://doi.org/10.1111/j.1365-2141.1990.tb04362.xCitations: 13AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume75, Issue3July 1990Pages 436-438 RelatedInformation

Primary Sjogren's syndrome presenting as a case of sarcoidosis and a suspected pancreatic tumour.

A 45 year old man, previously diagnosed as having sarcoid, presented with signs and symptoms of a pancreatic malignancy. An explorative laparotomy, however, showed only chronic pancreatitis. He was found to have a raised erythrocyte sedimentation rate, normocytic normochromic anaemia, renal insufficiency, hypergammaglobulinaemia, and a strongly positive rheumatoid factor and antinuclear antibody titre. Bilateral hilar lymph node enlargement was noted on chest x ray. Subsequently, the patient complained of xerostomia and keratoconjunctivitis sicca. Large lymphocytic infiltrates and a shift in the relative number of IgA bearing plasma cells in favour of IgG and IgM bearing plasma cells were seen in tissue obtained by sublabial salivary gland biopsy. A transbronchial lung biopsy and review of the biopsies of the pancreas, the lung, liver, and a lymph node all failed to show granulomatous disease. These findings strongly suggested a diagnosis of Sjögren's syndrome instead of sarcoidosis. This case shows the difficulty sometimes encountered in differentiating between sarcoid and systemic Sjögren's syndrome, and the value of a sublabial salivary gland biopsy.

Kann die digitale Lumineszenzradiographie (DLR) in der Thoraxdiagnostik die konventionelle Röntgenaufnahmetechnik ersetzen?

The image quality of digital luminescent radiography (DLR) is sufficient for routine biplane chest radiography and for follow-up studies of heart size, pulmonary congestion, coin lesions, infiltrations, atelectasis, pleural effusions, and mediastinal and hilar lymph node enlargement. Chest radiography in the intensive care unit may in most cases be performed using the DLR technique. There is no need for repeat shots because of incorrect exposure, and the position of catheters, tubes, pacemakers, drains and artificial heart valves, the mediastinum, and the retrocardiac areas of the left lung are more confidently assessed on the edge-enhanced DLR films than on conventional films. Nevertheless, DLR is somewhat inferior to conventional film-screen radiography of the chest as it can demonstrate or rule out subtle pulmonary interstitial disease less confidently. There is no reduction of radiation exposure of the chest in DLR compared with modern film-screen systems. As a consequence, DLR is presently not in a position to replace traditional film-screen radiography of the chest completely.

Pulmonary tuberculosis in patients with acquired immunodeficiency syndrome

An association between tuberculosis and HIV infection is becoming increasingly evident. HIV seropositivity has been seen in nearly 30% of some populations with tuberculosis. In other populations nearly 25% of patients with AIDS had tuberculosis. Clinically these patients present with nonspecific findings including weight loss, night sweats, and fever. The symptoms are generally gradual in onset and last for several weeks. Early in the course of HIV infection a PPD skin test may be positive and the radiographic findings may be similar to those seen in individuals with normal immunity. Thus, upper lobe heterogeneous and cavitary opacities may be seen on the chest radiograph. In late HIV infection, however, the PPD skin test is generally negative and the radiograph demonstrates lymphadenopathy and diffuse heterogeneous parenchymal opacities. Tuberculosis should be suspected in HIV-infected patients when diffuse interstitial lung disease is demonstrated in conjunction with hilar or mediastinal lymph node enlargement. In contrast, lymphadenopathy is not expected in the most common opportunistic lung disease, Pneumocystis carinii pneumonia. Standard antituberculous drug therapy is extremely effective in treating tuberculosis in this setting.

Frequency of extrathoracic metastases from bronchogenic carcinoma in patients with normal-sized hilar and mediastinal lymph nodes on CT.

The only cure for bronchogenic carcinoma is complete surgical resection; the most common reason for not attempting surgical resection is mediastinal adenopathy. However, we have found that even when the lymph nodes are normal in size, the presence of extrathoracic metastases may preclude successful resection. In a series of 263 patients with pathologically proved non-small cell bronchogenic carcinoma who were seen over a 2-year period, we identified 95 patients in whom a preoperative CT scan showed only a solitary lung mass without evidence of hilar or mediastinal metastases, pleural effusion, or definite chest-wall involvement. The medical records and preoperative imaging studies were evaluated in this group. Twenty-four (25%) of these patients who had potentially resectable masses proved to have extrathoracic metastases; thus they were not candidates for surgery. Occurring in 16 (67%) of these 24 patients, adenocarcinoma was the most common cell type; squamous cell carcinoma was present in five patients (21%), and large cell carcinoma was present in three patients (13%). These findings suggest that extrathoracic metastases from bronchogenic carcinoma may occur without CT evidence of enlarged hilar or mediastinal lymph nodes. Such metastases may preclude successful surgical resection.

Sarcoid-like hilar and mediastinal lymphadenopathy in a patient with metastatic testicular cancer

Previous reports indicate that enlarged hilar and mediastinal lymph nodes due to sarcoid-like reactions may develop after curative resection of testicular cancer, and their presence does not necessarily denote neoplastic recurrence. Reports further suggest that coexisting pulmonary nodules in this setting may be related to nodular sarcoidosis. A patient developed progressive hilar and mediastinal adenopathy associated with multiple pulmonary nodules after apparent curative resection of a testicular embryonal cell cancer. Biopsy specimens from the mediastinal lymph nodes demonstrated granulomas, suggesting the diagnosis of nodular sarcoidosis. Needle aspiration of the pulmonary nodules, however, revealed metastatic testis cancer. Sarcoid-like mediastinal reactions occur after resection of testis cancer, but biopsies should be performed on coexisting pulmonary nodules to exclude pulmonary metastases.

Sarcoid reaction of hilar and paratracheal lymph nodes in patients treated for testicular cancer

Bilateral hilar lymph node enlargement developed in four patients 1 to 8 years after successful radiotherapy for testicular cancer Stage I was performed. Two had additional paratracheal involvement. Biopsy showed sarcoid reaction in all four cases. An increased frequency of sarcoid reaction is assumed in patients treated for testicular cancer. The pathogenesis remains unknown. The clinical and radiologic findings should not be misinterpreted as showing recurrent malignant disease. In an otherwise disease-free patient in whom mediastinal lymph node enlargement develops, a biopsy should always be performed.

Primary malignant fibrous histiocytoma of the left atrium. Surgical and chemotherapeutic management.

A primary malignant fibrous histiocytoma of the left atrium was diagnosed in a 27 year old woman. After surgical excision the tumour recurred together with enlargement of the right hilar lymph nodes. The patient was then treated with nine courses of chemotherapy using a combined drug regimen. During the first course the tumour regressed, and after nine courses almost complete remission was achieved. Subsequently, the residual tumour was removed by resection of the right lung, the right hilar, paratracheal, and paraeosophageal lymph nodes and by cardiotomy with partial resection of the right and left atria and atrial septum followed by a reconstruction of the atrias. To date, more than two years after initial presentation, the patient is alive and well.

Azygos Lymph Node Enlargement as Initial Manifestation of Underlying Disease

Azygos lymph node enlargement is usually an indication of advanced bronchogenic carcinoma, although it may occur in benign pulmonary disease. Often it is found in conjunction with enlargement of hilar and other mediastinal lymph nodes. Isolated azygos lymph node enlargement is unusual and demands tissue diagnosis. Four patients without other evidence of underlying disease were evaluated because of roentgenographic finding of azygos lymph node enlargement. Three had malignant disease and one reactive lymphoid hyperplasia. Current concepts of mediastinal lymphatic drainage are presented. Because of the likelihood of underlying malignancy, biopsy examination of an enlarged azygos node by cervical mediastinoscopy is indicated.

Lymphangitic carcinomatosis of the lung in metastatic breast carcinoma

The lungs of 34 patients who had died of carcinoma of the breast and pulmonary lymphangitis carcinomatosa were prepared by air insufflation and then examined radiologically and histologically. The results were compared with x-ray examination performed just before death. The interstitial pattern of lymphangitis is due to tumour cell infiltration of septal, peri-vasal and peri-bronchial lymphatics, and to fibrosis. Pleural effusions developed in 17 patients and were twice as frequent on the side of the breast tumour. Hilar lymph node enlargement was found in only five cases, although histological involvement was proven in 19. Theories concerning the mode of propagation of pulmonary lymphangitis carcinomatosa are discussed.

Diffuse infiltrative lung disease: a new scheme for description.

A scheme was devised for semiquantitative description of the diffuse infiltrative lung diseases using the graphic terminology of the International Labour Office and Union Internationale Contre le Cancer (ILO/UC) classification. Conventions for grading the type (rounded or "pqr" and irregular or "stu"), severity (profusion in 12 steps), localization of opacities, and pleural disease were retained. Modifications included: (a) a third group of opacities, called "xyz," corresponding to reticulonodular patterns; (b) "ground glass" (alveolar) patterns, subdivided into 7 types by character and location; (c) notations for severity of emphysema; and (d) hilar node enlargement. This initial study concerned diagnostic aspects and therefore was limited to 365 cases proved by open biopsy. When this scheme was used without any knowledge of clinical data, the first two radiologic diagnostic choices corresponded with the principal histologic diagnosis in 50% of cases. The biopsy diagnosis was mentioned among the first three choices in 78% of cases. It is concluded that this classification provides an understandable and quantifiable system of communication and a tool for teaching, clinical research, and epidemiologic studies.

HLA-B8/DR3 in sarcoidosis. Correlation to acute onset disease with arthritis.

HLA-A, B, C and DR typing was performed in 19 patients with sarcoidosis of acute onset. Besides bilateral hilar lymph node enlargement (BHL), ankle joint involvement was found in all and erythema nodosum in seven. HLA-B8 was present in 13 and HLA-DR3 in 17 of the 19 patients. The joint manifestations and the erythema nodosum subsided in all within three months. The BHL regressed completely in seventeen patients during a three year observation period. In two patients with an observation period of one year and less than six months, respectively, BHL were still visible. The strong association between the acute, prognostically beneficial manifestation of sarcoidosis and HLA-DR3 might partly be related to the presence of circulating immune complexes in acute sarcoidosis as well as to an immunogenetically determined handling of a postulated etiological antigen.

Clinical course of retrovirus-associated adult T-cell lymphoma in the United States.

We studied the clinical features of 11 patients with adult T-cell lymphoma associated with the human T-cell lymphoma virus. The patients were predominantly young, black, and born in the southeastern United States. They had an aggressive course, with the rapid onset of disseminated skin lesions or symptoms related to hypercalcemia and other metabolic disturbances, or both. Common findings included rapid enlargement of peripheral, hilar, and retroperitoneal lymph nodes, with sparing of the mediastinum; invasion of the central nervous system, lungs, or gastrointestinal tract; and opportunistic infections. A paraneoplastic syndrome characterized by increased bone turnover, abnormal bone scintigraphy, and hypercalcemia was present in all patients. Intensive combination chemotherapy produced prompt complete clinical remissions, which were generally of short duration. Similar features have been described in patients in Japan and the West Indies who had adult T-cell lymphoma, which is also associated with the human T-cell lymphoma virus. This syndrome should be suspected in patients presenting with the acute onset of widespread T-cell lymphoma in association with metabolic bone disease and hypercalcemia. The presence of the syndrome can be confirmed by appropriate serologic and virologic studies.

Hilar and mediastinal lymph node metastases in malignant melanoma.

Of 65 patients with intrathoracic metastases from melanomon, 35 had metastasis to hilar or mediastinal nodes. In 28 of these 35, hilar and mediastinal lymph node enlargement was radiographically visible, hilar node enlargement was more commonly seen than mediastinal node enlargement. Pulmonary nodules were demonstrated radiographically in 25 of the 28 patients. Although lymph node enlargement was often asymmetric, symmetric hilar adenopathy mimicking sarcoidosis occurred in five of the 28 patients. Seven patients had unilateral involvement of lung and hilar and mediastinal nodes. In patients with melanoma, indirect metastatic spread via pulmonary nodules to hilar and mediastinal nodes may account for the frequent association of node metastases with lung nodules, the occurrence of intrathoracic adenopathy in the absence of extrathoracic node metastases, and the common finding of unilateral lung and nodal disease.