Mediastinal adenopathy/lymphadenopathy is the enlargement of lymph nodes in the central part of the chest. Lymph nodes may be enlarged secondary to infection, injury, blockage or cancer. This is usually an incidental finding on routine or follow up chest imaging (chest xray or CT scan).
There are no specific signs and symptoms of mediastinal adenopathy, but you may have signs and symptoms secondary to the cause of the adenopathy (infection or cancer).
If there imaging shows mediastinal adenopathy, your doctor may recommend biopsy of the inflamed/enlarged lymph nodes. This can be done utilizing some of the following interventions:
Endobronchial ultrasound (EBUS)
An endobronchial ultrasound (EBUS) is a bronchoscopic technique that uses ultrasound to view structures within the airway, lung, and mediastinum. This approach can be used in the diagnosis and staging of lung cancer, in diagnosing mediastinal lymphadenopathy of unclear etiology, in sampling/biopsying certain pulmonary nodules and endobronchial or peribronchial lesions, and in sampling mediastinal masses. We will often perform an EBUS with fine needle aspiration (FNA) in order to sample the tissue in question. The advantage in performing an EBUS versus another form of diagnostic testing is that this procedure is minimally invasive and is usually performed under moderate sedation (not general anesthesia).
Electromagnetic navigational bronchoscopy (ENB)
An electromagnetic navigational bronchoscopy (ENB) uses virtual technology and an electromagnetic field to target a distant lesion in the lung in order to obtain a biopsy. Similar to other bronchoscopies, the advantage of this procedure is that it is minimally invasive and is usually performed under moderate sedation.
Esophageal endoscopic ultrasound (EUS)An esophageal endoscopic ultrasound is a procedure where the surgeon enters the esophagus with an endoscope to view and/or biopsy esophageal masses, certain lung masses, and abnormal lymph nodes.
Radial Endobronchial ultrasound (REBUS)
Mediastinoscopy is a surgery performed either VATS or robotic assisted thoracoscopy in order to sample multiple lymph nodes in the mediastinum. This procedure is typically performed at the same time as a lung cancer resection, but sometimes is performed independently.A video assisted surgery is a minimally invasive lung surgery where the surgeon creates multiple small incisions in the chest and uses a video camera that sees into the chest in order to perform the procedure. Performing a VATS procedure will accomplish the same anatomic dissection as an open thoracotomy approach.Robot assisted thoracic surgery is a minimally invasive lung surgery similar to a VATS, but uses a unit (or “robot”) with multiple moveable arms that are controlled by the surgeon at a separate console.