Sarcoidosis and mediastinal lymphadenopathy

Mediastinal lymphadenopathy is swelling of the lymph nodes in the chest. The mediastinum is the central part of the chest between the lungs. Lymphadenopathy is a condition in which lymph nodes become enlarged. The mediastinum contains several structures, including the trachea, oesophagus, heart and major blood vessels. Mediastinal lymph nodes can enlarge for several reasons. In sarcoidosis, the enlargement is related to an inflammatory process caused by the immune reaction associated with the disease.

Symptoms of lymphadenopathy
• Fever
• Weight loss
• Night sweats
• Chest discomfort
• Frequent cough and/or shortness of breath
• Exhaustion
• Muscle weakness
• Joint pain

Because these symptoms and lymphadenopathy itself can also point to malignant or other serious diseases, a complete diagnostic assessment should be arranged promptly.

Lymph nodes
Lymph nodes are small, bean-shaped structures that form part of the lymphatic system. They help fight infections by filtering bacteria and viruses from the bloodstream and transporting immune cells through the body. Lymph nodes may swell or enlarge while they are filtering abnormal or harmful cells. Swollen lymph nodes, or lymphadenopathy, can occur when the immune system is responding to an infection.

In autoimmune disease, the immune system is reacting excessively. Similar symptoms may occur with conditions such as:
• Sarcoidosis
• Amyloidosis
• Tuberculosis (TB)
• Chronic obstructive pulmonary disease (COPD)
• Cystic fibrosis (CF)
• Coccidioidomycosis
• Certain autoimmune diseases, such as lupus
• Lymphoma

Treatment
Mediastinal lymphadenopathy is a symptom or consequence of an underlying disease rather than a disease in itself, so it has no separate direct treatment. Treatment is therefore directed at identifying and treating the underlying cause.

Diagnosis
In most cases, people cannot feel or see mediastinal lymphadenopathy because the lymph nodes in the chest lie deep inside the body. The symptoms may indicate a problem, after which doctors may request a chest X-ray, contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI). More invasive diagnostic procedures include mediastinoscopy, bronchoscopy and endobronchial ultrasound (EBUS), during which tissue may be sampled from abnormal areas of the mediastinum.

What is the lymphatic system?
Just as the cardiovascular system carries blood, the lymphatic system carries lymph fluid. It is a circulation system made up of lymph fluid and lymphatic vessels. Lymph flows through lymphatic vessels and eventually returns to the cardiovascular circulation. One of the lymphatic system’s roles is to help protect the body from microorganisms and foreign substances. An important function of lymph is the continuous removal of protein molecules from the spaces between cells.

Medical information on this page is educational and does not replace an examination or advice from a qualified healthcare professional.