What are the symptoms of pulmonary mediastinal lymphadenopathy?

The most obvious symptom of enlarged mediastinal lymph nodes in the lungs is that the patient will experience difficulty swallowing, difficulty breathing, or swelling and dull pain in the head and chest. Some patients may also experience symptoms such as weight loss, fatigue, and night sweats. These conditions must be diagnosed and treated accordingly.

1. Symptoms and Signs

Mediastinal lymphadenopathy may cause no specific symptoms. However, enlarged lymph nodes can compress the esophagus and cause difficulty in swallowing, and can also compress the trachea and cause difficulty in breathing. Compression of the superior vena cava may cause superior vena cava obstruction syndrome, in which the patient experiences swelling of the head, face, and upper chest. Symptoms of mediastinal compression are mostly caused by malignant tumors. A few tuberculous mediastinal lymphadenopathy forming mediastinal granulomas or extensive fibrosis can also cause superior vena cava obstruction syndrome.

2. Characteristics of the disease

1. A middle-aged male with fatigue, dry cough for 1 month, irregular fever and night sweats for 3 weeks, and a history of living abroad

2. Progressive weight loss

3. No obvious findings during physical examination

4. The chest plain film result was negative, and enhanced CT showed enlarged lymph nodes behind the vena cava in the right upper trachea, with uneven density and liquid dark areas inside. There is a ring-shaped enhancing mass protruding from the anterior wall of the right main bronchus, causing external compressive stenosis of the right main bronchus. Fibrous cords can be seen in the outer band of the right upper lobe. There is localized gathering of the right middle lobe lung texture.

5. The blood routine test showed that the erythrocyte sedimentation rate was relatively fast, and the white content in the blood routine test was relatively high.

6. General antibiotic treatment is ineffective

3. Disease Identification

1. In adults, the hilar and mediastinal lymph node tuberculosis lesions are located in the upper part and are relatively isolated, and may be accompanied by irregular fever, night sweats, weight loss, etc. The lesions of patients with liquefaction necrosis are more reactive and may have pleural reactions and pulmonary infiltration.

2. Lymphoma: There are often enlarged lymph nodes in multiple parts of the body, which are often fused into pieces, which is not consistent with the disease.

3. I once treated a case of necrotizing lymphadenitis, in which multiple lymph nodes were swollen throughout the body, and the body temperature was mostly low-grade or moderate fever. On CT, the mediastinal lymph nodes are slightly enlarged and have a relatively uniform texture.

4. Bronchogenic cyst and infection: The tumor is located on the anterior wall of the right main bronchus. Unless the infection is severe, there is rarely any enlargement of the mediastinal lymph nodes.

5. Lung cancer: Most cases of liquefaction necrosis are squamous cell carcinomas. The tumors are usually large, but those located in the cavity may be smaller.

6. Sarcoidosis: It is more common in women, and may cause pulmonary infiltration. The general condition is generally good.