Advertisement

Lung

, Volume 196, Issue 1, pp 43–48 | Cite as

Assessment of Mediastinal Lymph Node Size in Pneumococcal Pneumonia with Bacteremia

  • Amit Chopra
  • Aakash Modi
  • Haroon Chaudhry
  • Recai Yucel
  • Neha Rane
  • John Fantauzzi
  • Frederic J. Hellwitz
  • Marc A. Judson
Respiratory Infections
  • 58 Downloads

Abstract

Introduction

The significance of mediastinal lymphadenopathy in bacterial pneumonia is unclear.

Methods

We performed a retrospective analysis of mediastinal lymph node size determined by chest CT in patients with bacteremic pneumococcal pneumonia. All patients who had positive blood cultures for streptococcus pneumonia over an 11-year period and had a chest CT scan (index CT) within 2 weeks of the positive blood culture were included in the study. Two thoracic radiologists and one pulmonologist independently examined the index CT plus any chest CT scans performed prior (pre-CT) or after (post-CT) the bacteremic episode.

Results

The study cohort of 49 patients was 57% male, 65% White, with mean age of 53 (SD = 20) years. Mediastinal lymphadenopathy was detected in 25/49 (51%) of the cases. The mean size of the largest mediastinal lymph node in short axis was 0.99 (SD = 0.71), ranging from 0.0 to 2.05 cm. There was no correlation noted between the number of lobes involved with pneumonia, and the size of the largest mediastinal lymph node (p = 0.33) or the number of pathologically enlarged mediastinal lymph nodes (p = 0.08). There was a statistically significant increase in the mean size of the largest lymph node between the pre-CT and index-CT group (p = 0.02), and decrease between the index-CT group and the post-CT (p = 0.03).

Conclusion

Pneumococcal pneumonia with bacteremia is associated with mild mediastinal lymph node enlargement. The presence of marked mediastinal lymphadenopathy (short axis LN size > 2 cm) should not be assumed from pneumococcal pneumonia.

Keywords

Bacteremia Computed tomography Mediastinal lymphadenopathy Pneumonia Streptococcus pneumoniae 

Notes

Author Contribution

MAJ is the guarantor of the paper, and takes responsibility for the integrity of the work as a whole, from inception to published article. All authors were involved in the study design. SC, AM, HC, NR, performed the data collection and data entry. Two radiologists, JF and FJH, interpreted the CT scan reports. RY performed the statistical analysis. All authors contributed to the writing of the manuscript.

Compliance with Ethical Standards

Conflicts of interest

MAJ consultant for Janssen, Celgene, Questcor, Mistubishi-Tanabe, Novartis. AC, SC, AM, HC, NR, JH, FJH declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee. The Institutional Review Board of Albany Medical College approved this study

References

  1. 1.
    Silvestri GA, Gonzalez AV, Jantz MA, Margolis ML, Gould MK, Tanoue LT, Harris LJ, Detterbeck FC (2013) Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143:e211S–e250SCrossRefPubMedGoogle Scholar
  2. 2.
    Manucha V, Kaur G, Verma K (2013) Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of mediastinal lymph nodes: experience from region with high prevalence of tuberculosis. Diagn Cytopathol 41:1019–1022CrossRefPubMedGoogle Scholar
  3. 3.
    Stigt JA, Boers JE, Oostdijk AH, van den Berg JW, Groen HJ (2011) Mediastinal incidentalomas. J Thorac Oncol 6:1345–1349CrossRefPubMedGoogle Scholar
  4. 4.
    Souza CA, Muller NL, Lee KS, Johkoh T, Mitsuhiro H, Chong S (2006) Idiopathic interstitial pneumonias: prevalence of mediastinal lymph node enlargement in 206 patients. AJR Am J Roentgenol 186:995–999CrossRefPubMedGoogle Scholar
  5. 5.
    Pastis NJ Jr, Van Bakel AB, Brand TM, Ravenel JG, Gilbert GE, Silvestri GA, Judson MA (2011) Mediastinal lymphadenopathy in patients undergoing cardiac transplant evaluation. Chest 139:1451–1457CrossRefPubMedGoogle Scholar
  6. 6.
    Hassan T, McLaughlin AM, O’Connell F, Gibbons N, Nicholson S, Keane J (2011) EBUS-TBNA performs well in the diagnosis of isolated thoracic tuberculous lymphadenopathy. Am J Respir Crit Care Med 183:136–137CrossRefPubMedGoogle Scholar
  7. 7.
    Heddurshetti R, Pumpradit W, Lutwick LI (2001) Pulmonary manifestations of bioterrorism. Curr Infect Dis Rep 3:249–257CrossRefPubMedGoogle Scholar
  8. 8.
    Tarnvik A, Berglund L (2003) Tularaemia. Eur Respir J 21:361–373CrossRefPubMedGoogle Scholar
  9. 9.
    Muller NL, Webb WR, Gamsu G (1985) Subcarinal lymph node enlargement: radiographic findings and CT correlation. AJR Am J Roentgenol 145:15–19CrossRefPubMedGoogle Scholar
  10. 10.
    Schmidt AF Jr, Rodrigues OR, Matheus RS, Kim Jdu U, Jatene FB (2007) Mediastinal lymph node distribution, size and number: definitions based on an anatomical study. J Bras Pneumol 33:134–140CrossRefPubMedGoogle Scholar
  11. 11.
    Stein DL, Haramati LB, Spindola-Franco H, Friedman J, Klapper PJ (2005) Intrathoracic lymphadenopathy in hospitalized patients with pneumococcal pneumonia. Chest 127:1271–1275PubMedGoogle Scholar
  12. 12.
    Woodhead M (2002) Community-acquired pneumonia in Europe: causative pathogens and resistance patterns. Eur Respir J Suppl 36:20s–27sCrossRefPubMedGoogle Scholar
  13. 13.
    Ruiz M, Ewig S, Marcos MA, Martinez JA, Arancibia F, Mensa J, Torres A (1999) Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. Am J Respir Crit Care Med 160:397–405CrossRefPubMedGoogle Scholar
  14. 14.
    Torres A (1999) Re-evaluation of the etiology of community-acquired pneumonia: the impact of the age of comorbidity and of the severity of the pneumonia and of other additional factors. Arch Bronconeumol 35(Suppl 3):62–64PubMedGoogle Scholar
  15. 15.
    Craven DE, Steger KA (1995) Epidemiology of nosocomial pneumonia. New perspectives on an old disease. Chest 108:1S–16SCrossRefPubMedGoogle Scholar
  16. 16.
    Macfarlane JT, Miller AC, Roderick Smith WH, Morris AH, Rose DH (1984) Comparative radiographic features of community acquired Legionnaires’ disease, pneumococcal pneumonia, mycoplasma pneumonia, and psittacosis. Thorax 39:28–33CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Okada F, Ando Y, Matsushita S, Ishii R, Nakayama T, Morikawa K, Ono A, Maeda T, Mori H (2012) Thin-section CT findings of patients with acute Streptococcus pneumoniae pneumonia with and without concurrent infection. Br J Radiol 85:e357–e364CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Nambu A, Saito A, Araki T, Ozawa K, Hiejima Y, Akao M, Ohki Z, Yamaguchi H (2006) Chlamydia pneumoniae: comparison with findings of Mycoplasma pneumoniae and Streptococcus pneumoniae at thin-section CT. Radiology 238:330–338CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care Medicine, Department of MedicineAlbany Medical CollegeAlbanyUSA
  2. 2.Department of Epidemiology and BiostatisticsSchool of Public Health, SUNY at AlbanyRensselaerUSA
  3. 3.Department of RadiologyAlbany Medical CenterAlbanyUSA

Personalised recommendations