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Anesthesiology285 papers

Pulmonary lymphadenopathy

Last edited: 4/14/2026

Overview

Pulmonary lymphadenopathy refers to the enlargement of lymph nodes within the chest cavity, often indicative of underlying infectious, inflammatory, or neoplastic processes. It is a significant diagnostic challenge requiring precise evaluation to determine the etiology.

Diagnosis

  • Clinical Evaluation: Comprehensive history and physical examination to identify potential causes 2.
  • Imaging: Chest CT or PET scans to assess lymph node size, morphology, and metabolic activity 12.
  • Endobronchial Ultrasound-Guided Techniques:
    • - EBUS-TBNA (Transbronchial Needle Aspiration): Primary technique for tissue sampling; combined with EBUS-IFB (Intranodal Forceps Biopsy) may enhance diagnostic yield 13. - EBUS-TBNB (Transbronchial Node Biopsy): Alternative method to improve specimen quality, particularly useful in lymphoma and sarcoidosis 1.
  • Cytology and Histopathology: Rapid on-site evaluation (ROSE) by pulmonologists can aid in assessing specimen adequacy 11.
  • Fine Needle Aspiration (FNA): Useful in pediatric populations and for cervical lymphadenopathy 714.

    • Management

  • Infectious Causes: Specific antimicrobial therapy based on identified pathogens 2424.
  • Neoplastic Causes:
    • - Lymphoma: Chemotherapy regimens such as R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) 2. - Sarcoidosis: Corticosteroids or immunomodulatory agents like methotrexate 2.
  • Obstructive Symptoms: Management of symptoms with corticosteroids or other supportive care 24.

    • Special Populations

  • Pediatrics: EBUS-TBNA and EUS-B-FNA are safe and effective for evaluating mediastinal lymphadenopathy 7.
  • Elderly: Consider comorbidities and potential drug interactions when selecting treatment regimens 2.
  • Comorbidities: Tailor diagnostic and therapeutic approaches considering coexisting conditions like hypertriglyceridemia or drug addiction 2017.

    • Key Recommendations

  • Utilize EBUS-guided techniques, including EBUS-TBNA and potentially EBUS-IFB, for optimal diagnostic yield in pulmonary lymphadenopathy 13 (Evidence: Strong).
  • Incorporate rapid on-site cytologic evaluation (ROSE) to enhance the adequacy of transbronchial needle aspiration samples 11 (Evidence: Moderate).
  • Tailor diagnostic approaches in pediatric patients using minimally invasive techniques like EBUS-TBNA 7 (Evidence: Moderate).
  • Consider specific etiologies (infectious, neoplastic) and tailor treatments accordingly, guided by definitive diagnostic results 24 (Evidence: Strong).
  • Evaluate cervical lymphadenopathy in children with fine needle aspiration cytology (FNAC) for accurate etiologic workup 14 (Evidence: Moderate).

    • References

    1 Yang W, Yang H, Zhang Q, Herth FJF, Zhang X. Comparison between Endobronchial Ultrasound-Guided Transbronchial Node Biopsy and Transbronchial Needle Aspiration: A Meta-Analysis. Respiration; international review of thoracic diseases 2024. link 2 Rodolfi S, Della-Torre E, Bongiovanni L, Mehta P, Fajgenbaum DC, Selmi C. Lymphadenopathy in the rheumatology practice: a pragmatic approach. Rheumatology (Oxford, England) 2024. link 3 Agrawal A, Ghori U, Chaddha U, Murgu S. Combined EBUS-IFB and EBUS-TBNA vs EBUS-TBNA Alone for Intrathoracic Adenopathy: A Meta-Analysis. The Annals of thoracic surgery 2022. link 4 Khemasuwan D, Teerapuncharoen K, Griffin DC. Diagnostic Yield and Safety of Bronchoscopist-directed Moderate Sedation With a Bolus Dose Administration of Propofol During Endobronchial Ultrasound Bronchoscopy. Journal of bronchology & interventional pulmonology 2018. link 5 Öztaş S, Aka Aktürk Ü, Alpay LA, Meydan B, Ogün H, Taylan M et al.. A comparison of propofol-midazolam and midazolam alone for sedation in endobronchial ultrasound-guided transbronchial needle aspiration: a retrospective cohort study. The clinical respiratory journal 2017. link 6 Beaudoin S, Martel S, Pelletier S, Lampron N, Simon M, Laberge F et al.. Randomized Trial Comparing Patient Comfort Between the Oral and Nasal Insertion Routes for Linear Endobronchial Ultrasound. Journal of bronchology & interventional pulmonology 2016. link 7 Dhooria S, Madan K, Pattabhiraman V, Sehgal IS, Mehta R, Vishwanath G et al.. A multicenter study on the utility and safety of EBUS-TBNA and EUS-B-FNA in children. Pediatric pulmonology 2016. link 8 Stather DR, Chee A, MacEachern P, Dumoulin E, Hergott CA, Gelberg J et al.. Endobronchial ultrasound learning curve in interventional pulmonary fellows. Respirology (Carlton, Vic.) 2015. link 9 Madan K, Garg P, Kabra SK, Mohan A, Guleria R. Transesophageal Bronchoscopic Ultrasound-guided Fine-needle Aspiration (EUS-B-FNA) in a 3-Year-Old Child. Journal of bronchology & interventional pulmonology 2015. link 10 Chiappini E, Camaioni A, Benazzo M, Biondi A, Bottero S, De Masi S et al.. Development of an algorithm for the management of cervical lymphadenopathy in children: consensus of the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases and the Italian Society of Pediatric Otorhinolaryngology. Expert review of anti-infective therapy 2015. link 11 Bonifazi M, Sediari M, Ferretti M, Poidomani G, Tramacere I, Mei F et al.. The role of the pulmonologist in rapid on-site cytologic evaluation of transbronchial needle aspiration: a prospective study. Chest 2014. link 12 Beaudoin S, Ferland N, Martel S, Delage A. Feasibility of using the nasal route for linear endobronchial ultrasound. Lung 2014. link 13 Boonsarngsuk V, Pongtippan A. Self-learning experience in transbronchial needle aspiration in diagnosis of intrathoracic lymphadenopathy. Journal of the Medical Association of Thailand = Chotmaihet thangphaet 2009. link 14 Annam V, Kulkarni MH, Puranik RB. Clinicopathologic profile of significant cervical lymphadenopathy in children aged 1-12 years. Acta cytologica 2009. link 15 Linssen J, Jennissen V, Hildmann J, Reisinger E, Schindler J, Malchau G et al.. Identification and quantification of high fluorescence-stained lymphocytes as antibody synthesizing/secreting cells using the automated routine hematology analyzer XE-2100. Cytometry. Part B, Clinical cytometry 2007. link 16 Palmeri D, Zuo FR, Rosen SD, Hemmerich S. Differential gene expression profile of human tonsil high endothelial cells: implications for lymphocyte trafficking. Journal of leukocyte biology 2004. link 17 Kumral A, Olgun N, Uysal KM, Corapcioğlu F, Oren H, Sarialioğlu F. Assessment of peripheral lymphadenopathies: experience at a pediatric hematology-oncology department in Turkey. Pediatric hematology and oncology 2002. link 18 Yardley MP. Investigation of cervical lymphadenopathy presumed to be metastatic in nature: a review of current clinical practice. Journal of the Royal College of Surgeons of Edinburgh 1992. link 19 Lau CP, Wong KL, Wong CK, Leung WH. Acute lymphadenopathy complicating quinidine therapy. Postgraduate medical journal 1990. link 20 Leaf DA, Illingworth DR, Connor WE. Lymphadenopathy associated with severe hypertriglyceridemia. JAMA 1990. link 21 Kelly CA, Malcolm AJ. The significance of hyperplastic lymphadenopathy. British journal of hospital medicine 1987. link 22 Carbone A, Manconi R, Volpe R, Poletti A, De Paoli P, Tirelli U et al.. Immunohistochemical, enzyme histochemical, and immunologic features of giant lymph node hyperplasia of the hyaline-vascular type. Cancer 1986. link58:4<908::aid-cncr2820580418>3.0.co;2-1) 23 Garcia CF, Lifson JD, Engleman EG, Schmidt DM, Warnke RA, Wood GS. The immunohistology of the persistent generalized lymphadenopathy syndrome (PGL). American journal of clinical pathology 1986. link 24 Ghimire MP, Walker RJ. Painful dysphagia in a case of mediastinal tuberculous lymphadenopathy. Postgraduate medical journal 1985. link 25 Toccanier MF, Kapanci Y. Lymphadenopathy in drug addicts. A study of the distribution of T lymphocyte subsets in the lymph nodes. Virchows Archiv. A, Pathological anatomy and histopathology 1985. link 26 Leaper DJ, Evans M, Pollock AV. Colour lymphography in clinical surgery. The British journal of surgery 1979. link 27 Bendl BJ, Asano K, Lewis RJ. Nodular angioblastic hyperplasia with eosinophilia and lymphofolliculosis. Cutis 1977. link 28 Pripstein S, Culiner MM, Brodey PA. Roentgenographic demonstration of peripheral intrapulmonic lymphadenopathy. Radiology 1976. link

    Original source

    1. [1]
      Comparison between Endobronchial Ultrasound-Guided Transbronchial Node Biopsy and Transbronchial Needle Aspiration: A Meta-Analysis. — Yang W, Yang H, Zhang Q, Herth FJF, Zhang X Respiration; international review of thoracic diseases (2024)
    2. [2]
      Lymphadenopathy in the rheumatology practice: a pragmatic approach. — Rodolfi S, Della-Torre E, Bongiovanni L, Mehta P, Fajgenbaum DC, Selmi C Rheumatology (Oxford, England) (2024)
    3. [3]
      Combined EBUS-IFB and EBUS-TBNA vs EBUS-TBNA Alone for Intrathoracic Adenopathy: A Meta-Analysis. — Agrawal A, Ghori U, Chaddha U, Murgu S The Annals of thoracic surgery (2022)
    4. [4]
      Diagnostic Yield and Safety of Bronchoscopist-directed Moderate Sedation With a Bolus Dose Administration of Propofol During Endobronchial Ultrasound Bronchoscopy. — Khemasuwan D, Teerapuncharoen K, Griffin DC Journal of bronchology & interventional pulmonology (2018)
    5. [5]
      A comparison of propofol-midazolam and midazolam alone for sedation in endobronchial ultrasound-guided transbronchial needle aspiration: a retrospective cohort study. — Öztaş S, Aka Aktürk Ü, Alpay LA, Meydan B, Ogün H, Taylan M et al. The clinical respiratory journal (2017)
    6. [6]
      Randomized Trial Comparing Patient Comfort Between the Oral and Nasal Insertion Routes for Linear Endobronchial Ultrasound. — Beaudoin S, Martel S, Pelletier S, Lampron N, Simon M, Laberge F et al. Journal of bronchology & interventional pulmonology (2016)
    7. [7]
      A multicenter study on the utility and safety of EBUS-TBNA and EUS-B-FNA in children. — Dhooria S, Madan K, Pattabhiraman V, Sehgal IS, Mehta R, Vishwanath G et al. Pediatric pulmonology (2016)
    8. [8]
      Endobronchial ultrasound learning curve in interventional pulmonary fellows. — Stather DR, Chee A, MacEachern P, Dumoulin E, Hergott CA, Gelberg J et al. Respirology (Carlton, Vic.) (2015)
    9. [9]
      Transesophageal Bronchoscopic Ultrasound-guided Fine-needle Aspiration (EUS-B-FNA) in a 3-Year-Old Child. — Madan K, Garg P, Kabra SK, Mohan A, Guleria R Journal of bronchology & interventional pulmonology (2015)
    10. [10]
      Development of an algorithm for the management of cervical lymphadenopathy in children: consensus of the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases and the Italian Society of Pediatric Otorhinolaryngology. — Chiappini E, Camaioni A, Benazzo M, Biondi A, Bottero S, De Masi S et al. Expert review of anti-infective therapy (2015)
    11. [11]
      The role of the pulmonologist in rapid on-site cytologic evaluation of transbronchial needle aspiration: a prospective study. — Bonifazi M, Sediari M, Ferretti M, Poidomani G, Tramacere I, Mei F et al. Chest (2014)
    12. [12]
      Feasibility of using the nasal route for linear endobronchial ultrasound. — Beaudoin S, Ferland N, Martel S, Delage A Lung (2014)
    13. [13]
      Self-learning experience in transbronchial needle aspiration in diagnosis of intrathoracic lymphadenopathy. — Boonsarngsuk V, Pongtippan A Journal of the Medical Association of Thailand = Chotmaihet thangphaet (2009)
    14. [14]
      Clinicopathologic profile of significant cervical lymphadenopathy in children aged 1-12 years. — Annam V, Kulkarni MH, Puranik RB Acta cytologica (2009)
    15. [15]
      Identification and quantification of high fluorescence-stained lymphocytes as antibody synthesizing/secreting cells using the automated routine hematology analyzer XE-2100. — Linssen J, Jennissen V, Hildmann J, Reisinger E, Schindler J, Malchau G et al. Cytometry. Part B, Clinical cytometry (2007)
    16. [16]
      Differential gene expression profile of human tonsil high endothelial cells: implications for lymphocyte trafficking. — Palmeri D, Zuo FR, Rosen SD, Hemmerich S Journal of leukocyte biology (2004)
    17. [17]
      Assessment of peripheral lymphadenopathies: experience at a pediatric hematology-oncology department in Turkey. — Kumral A, Olgun N, Uysal KM, Corapcioğlu F, Oren H, Sarialioğlu F Pediatric hematology and oncology (2002)
    18. [18]
      Investigation of cervical lymphadenopathy presumed to be metastatic in nature: a review of current clinical practice. — Yardley MP Journal of the Royal College of Surgeons of Edinburgh (1992)
    19. [19]
      Acute lymphadenopathy complicating quinidine therapy. — Lau CP, Wong KL, Wong CK, Leung WH Postgraduate medical journal (1990)
    20. [20]
      Lymphadenopathy associated with severe hypertriglyceridemia. — Leaf DA, Illingworth DR, Connor WE JAMA (1990)
    21. [21]
      The significance of hyperplastic lymphadenopathy. — Kelly CA, Malcolm AJ British journal of hospital medicine (1987)
    22. [22]
      Immunohistochemical, enzyme histochemical, and immunologic features of giant lymph node hyperplasia of the hyaline-vascular type. — Carbone A, Manconi R, Volpe R, Poletti A, De Paoli P, Tirelli U et al. Cancer (1986)
    23. [23]
      The immunohistology of the persistent generalized lymphadenopathy syndrome (PGL). — Garcia CF, Lifson JD, Engleman EG, Schmidt DM, Warnke RA, Wood GS American journal of clinical pathology (1986)
    24. [24]
      Painful dysphagia in a case of mediastinal tuberculous lymphadenopathy. — Ghimire MP, Walker RJ Postgraduate medical journal (1985)
    25. [25]
      Lymphadenopathy in drug addicts. A study of the distribution of T lymphocyte subsets in the lymph nodes. — Toccanier MF, Kapanci Y Virchows Archiv. A, Pathological anatomy and histopathology (1985)
    26. [26]
      Colour lymphography in clinical surgery. — Leaper DJ, Evans M, Pollock AV The British journal of surgery (1979)
    27. [27]
      Nodular angioblastic hyperplasia with eosinophilia and lymphofolliculosis. — Bendl BJ, Asano K, Lewis RJ Cutis (1977)
    28. [28]
      Roentgenographic demonstration of peripheral intrapulmonic lymphadenopathy. — Pripstein S, Culiner MM, Brodey PA Radiology (1976)
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