PURPOSE: To reproduce the previous data that suggests such high association. Previous studies suggested high rate mediastinal lymphadenopathy in patients with congestive heart failure exacerbation (Slanetz, et al 54% and Valerie et al 42%). The suggestion of not working it up may help decreasing the burden on patients and on our health system.
METHODS: A retrospective chart review study. A total of 628 charts were reviewed. For patients who were included in the study, we reviewed the thorax computerized tomography report for any reported mediastinal lymphadenopathy. In those with reported lymph nodes, the chart was reviewed for any subsequent identification of any of the exclusion diagnosis, and for any thorax computerized tomography done without congestive heart failure exacerbation.
RESULTS: 113 had a concurrent computerized tomography scan done to rule out other etiologies (mostly pulmonary embolism). After name, age and medical record number comparison to avoid names repetition, we end up with total of 73 patients; 32 of them had reported lymphadenopathy 43.7 %, while 41 did not 55.6 %. Nine of the 32 patients who had computerized tomography with positive lymphadenopathy had another chest computerized tomography done later without heart failure exacerbation; seven of them (77.8%) had no reported lymphadenopathy, and two (22.2%) had the lymphadenopathy on the repeated one. All patients had two years follow up report available after the initial computerized tomography scan; none developed any of the exclusion diagnosis.
CONCLUSION: There is a high rate of association between CHF exacerbation and mediastinal lymphadenopathy. Therefore, we advise to repeat CT scan when the patient is out of the acute state and the heart function is optimized.
CLINICAL IMPLICATIONS: we suggest repeating the chest computerized tomography scan for patients in congestive heart failure exacerbation and a newly found mediastinal lymphadenopathy; this should be done when patient is not in heart failure and when cardiac function is optimized; if the lymphadenopathy persist then further work up is justified.
DISCLOSURE: Ghayyath Sultan, No Financial Disclosure Information; No Product/Research Disclosure Information