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What Does "Mild Mediastinal And Left Hilar Lymphadenopathy" Mean?
Question: hi my family member recently went thru a health crisis where she had on and off bronchitis for over 6 months, she also had high esonophils in her blood and she kept getting full body hives. when they did a CT of her chest they found Mild mediastinal and left hilar lymphadenopathy, they ended up biopsying it.....thru a bronchoscopy. the biopsy came back negative. she got better, the hives went away and the high esonophils went back to normal now.... she had a repeat CT of her chest and she still has some Mild mediastinal and left hilar lymphadenopathy, what are the chances shes has a serious disease ? she doesn't have any symptoms now and is perfectly healthy. the doctor wants to do ANOTHER biopsy . why ? this has me anxious..... why does she have these swollen nodes? she is a non smoker, her blood work is back to normal she has NO symptoms, no weight loss no fevers, she hasn't been sick in a long time, she has no other swollen glands, no hives, no bronchitis , no wheezing. she doesn't smoke, she has no history of cancer. her only past history is possible asthma. Please could these lymphnodes just be a sensitivity reaction nor due to bronchitis or asthma or chronic allergies , (shes has HORRIBLE allergies her entire life)
Brief Answer:
A sarcoidosis picture is more likely.
Detailed Answer:
Hi XXXX
Thanks for writing in to us.
I have read your query in detail.
After having seen and reviewed patients having mediastinal lymph nodes and peripheral eosinophilia, the first condition that I can think of is sarcoidosis. The condition sarcoidosis has got many varied presentations and you cannot expect a particular fixed set of findings in this condition.
In approximately half of the patients, it can show no significant symptoms. Studies show that the most common manifestation is bilateral hilar and mediastinal nodal enlargement, which is seen at some stage during the illness in over three quarters of patients.
If the nodes are large and accesssible to CT scan guided biopsy then I suggest proceeding with the procedure and confirming it.
What you have mentioned as bronchitis can be lung manifestation of sarcoidosis.
A malignancy cannot be completely ruled out but if there is no symptom like persistent weight loss, cough, fever, swellings elsewhere in the body then it is less likely.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
A sarcoidosis picture is more likely.
Detailed Answer:
Hi XXXX
Thanks for writing in to us.
I have read your query in detail.
After having seen and reviewed patients having mediastinal lymph nodes and peripheral eosinophilia, the first condition that I can think of is sarcoidosis. The condition sarcoidosis has got many varied presentations and you cannot expect a particular fixed set of findings in this condition.
In approximately half of the patients, it can show no significant symptoms. Studies show that the most common manifestation is bilateral hilar and mediastinal nodal enlargement, which is seen at some stage during the illness in over three quarters of patients.
If the nodes are large and accesssible to CT scan guided biopsy then I suggest proceeding with the procedure and confirming it.
What you have mentioned as bronchitis can be lung manifestation of sarcoidosis.
A malignancy cannot be completely ruled out but if there is no symptom like persistent weight loss, cough, fever, swellings elsewhere in the body then it is less likely.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
she had a biopsy done , and It was negative . negative for what I do not know but it didn't show anything because they never gave her a diagnosis, is it possible for her to have sarcoid but it she was starting to get over it and the biopsy didn't show it ? and do those lymphnodes go back down after the sarcoidosis is over?
Brief Answer:
Sarcoidosis can improve and reappear after few months to years.
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
Sarcoidosis can appear and resolve after some weeks only to reappear again few months later. So the possibility of sarcoidosis features and lymphnodes not being seen due to disease resolution is always there.
Sometimes it is difficult to give a confirmatory diagnosis on a single biopsy. There must be a provisional diagnosis in the mind of the doctors treating your relative. Sarcoidosis can remain an evasive diagnosis and require more than one biopsy.
A negative result in biopsy does not rule out a diagnosis unless specifically mentioned. If the doctors were suspecting similar conditions like tuberculosis or malignancy then it is possible to write "negative for tuberculosis" or negative for malignancy". If the biopsy material was less then it is usually mentioned as "inconclusive results due to inadequate tissue sample".
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Sarcoidosis can improve and reappear after few months to years.
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
Sarcoidosis can appear and resolve after some weeks only to reappear again few months later. So the possibility of sarcoidosis features and lymphnodes not being seen due to disease resolution is always there.
Sometimes it is difficult to give a confirmatory diagnosis on a single biopsy. There must be a provisional diagnosis in the mind of the doctors treating your relative. Sarcoidosis can remain an evasive diagnosis and require more than one biopsy.
A negative result in biopsy does not rule out a diagnosis unless specifically mentioned. If the doctors were suspecting similar conditions like tuberculosis or malignancy then it is possible to write "negative for tuberculosis" or negative for malignancy". If the biopsy material was less then it is usually mentioned as "inconclusive results due to inadequate tissue sample".
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My last question would be . her symptoms started in November of 2013 (which was bronchitis like symptoms and asthmatic like symptoms) and continued on and off till about XXXXXXX then she had chronic hives from about XXXXXXX till the end of July and then it all suddenly went away. and all her labs went to normal, does sarcoid sometimes llast like that , that long ? during the time she had the "bronchitis" she was placed on prednisone , that made her symptoms disappear then when she went off prednisone it came back.. but again since July everything disappeared and she has not been on ANY medications since. The interesting thing I find is that we have another relative with Rhematoid Arthritis and I myself , have lupus, does sarcoid tend to run with those with autoimmune disease? does autoimmune and sarcoid seem to better fit the diagnosis rather than cancer? and can one live a normal life after they have sarcoid? that's all my questions thank you so much for your help
Brief Answer:
Welcome and please find requested details below.
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
The condition sarcoidosis is known to behave similar to rheumatoid arthritis and lupus in terms of disease progression and intermittent resolution with treatment curves also showing common characteristics. The basis for these conditions is autoimmune disease.
The above mentioned features of bronchitis like clinical picture, hives and response to treatment with steroids, these can be expected in a case of sarcoidosis.
Your interpretation of sarcoidosis having a connection with autoimmune disease is correct.
Cancer is in itself a broad term when we talk about disease progression and quality of life. I have worked with many cancer patients and if detected in early stages, recovery is remarkable except in few types of cancer in which even early disease has a bad prognosis.
Keeping cancer and autoimmune diseases on the same platform may not be justified.
However, if you are interested in knowing about the time a patient has in his hands is usually longer in autoimmune diseases and can often be in years. Cancer on the other hand can be unpredictable.
Wishing the best of health to you and your family.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Welcome and please find requested details below.
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
The condition sarcoidosis is known to behave similar to rheumatoid arthritis and lupus in terms of disease progression and intermittent resolution with treatment curves also showing common characteristics. The basis for these conditions is autoimmune disease.
The above mentioned features of bronchitis like clinical picture, hives and response to treatment with steroids, these can be expected in a case of sarcoidosis.
Your interpretation of sarcoidosis having a connection with autoimmune disease is correct.
Cancer is in itself a broad term when we talk about disease progression and quality of life. I have worked with many cancer patients and if detected in early stages, recovery is remarkable except in few types of cancer in which even early disease has a bad prognosis.
Keeping cancer and autoimmune diseases on the same platform may not be justified.
However, if you are interested in knowing about the time a patient has in his hands is usually longer in autoimmune diseases and can often be in years. Cancer on the other hand can be unpredictable.
Wishing the best of health to you and your family.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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