Abstracts
Mediastinal lymphadenomegaly secondary to hypervolemia is an underdiagnosed tomographic finding. Herein we describe, in a patient with normal cardiac function, findings of pulmonary congestion associated to lymph node enlargement. The nephrotic syndrome causing hypoalbuminemia, low plasma colloid osmotic pressure and augmented transcapillary fluid leakage was the probable cause of the radiological findings.
Scleroderma, systemic; lymphoma; mediastinum; nephrotic syndrome
Linfadenomegalias mediastinais secundárias a hipervolemia são achados tomográficos subdiagnosticados. Descrevemos neste paciente com função cardíaca normal, achados de congestão pulmonar associados a alargamento dos linfonodos mediastinais. A síndrome nefrótica causando hipoalbuminemia, baixa pressão oncótica plasmática e aumento da pressão transcapilar foi a causa provável dos achados radiológicos.
Escleroderma sistêmico; linfoma; mediastino; síndrome nefrótica
CASE REPORT
Transient lymphadenopathy secondary to nephrotic syndrome
Olívia Meira Dias; André Nathan Costa; Carlos Roberto Ribeiro Carvalho; Ronaldo Adib Kairalla
Instituto do Coração (Incor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
Correspondence
ABSTRACT
Mediastinal lymphadenomegaly secondary to hypervolemia is an underdiagnosed tomographic finding. Herein we describe, in a patient with normal cardiac function, findings of pulmonary congestion associated to lymph node enlargement. The nephrotic syndrome causing hypoalbuminemia, low plasma colloid osmotic pressure and augmented transcapillary fluid leakage was the probable cause of the radiological findings.
Keywords: Scleroderma, systemic; lymphoma; mediastinum; nephrotic syndrome.
A 57-year-old man with systemic scleroderma and occupational silica exposure presented a two-month history of progressive dyspnea and peripheral edema. Physical examination revealed anasarca, pulmonary bibasilar crackles and hypoxemia (SatpO2 80%).
Contrasted high-resolution computed tomography scan (HRCT) of the chest revealed enlarged mediastinal lymph nodes and mediastinal fat associated to bilateral diffuse ground-glass infiltrates and interlobular septal thickening with predominance in the superior lobes, without arterial thrombi. The echocardiogram was unremarkable, and renal biopsy was diagnostic of nephrotic syndrome secondary to focal segmental glomerulosclerosis.
After prednisone and treatment with diuretics, the edema and dyspnea significantly improved. HRCT performed two months later showed resolution of the signs of pulmonary congestion and involution of mediastinal lymph node and fat enlargement (Figure 1).
Mediastinal lymphadenomegaly secondary to hypervolemia is an underdiagnosed tomographic finding1-9. Its incidence may arise in 55% of patients with symptomatic congestive heart failure1. They are usually located in the pretracheal area and have < 2 cm in short axis diameter10. Differential diagnosis to this case would include malignancies, lymphoma and sarcoidosis.
In this study, we describe a patient with normal cardiac function, findings of pulmonary congestion associated to lymph node enlargement. The nephrotic syndrome causing hypoalbuminemia, low plasma colloid osmotic pressure and augmented transcapillary fluid leakage was the probable cause of the radiological findings. To our surprise, even lymph nodes with peripheral calcification can enlarge due to edema. The rapid improvement after treatment, together with resolution of parenchyma findings of congestion, leads us to the diagnosis without an invasive procedure.
Potential Conflict of Interest
No potential conflict of interest relevant to this article was reported.
Sources of Funding
There were no external funding sources for this study.
Study Association
This study is not associated with any post-graduation program.
References
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Publication Dates
-
Publication in this collection
31 July 2012 -
Date of issue
May 2012
History
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Received
29 May 2011 -
Accepted
28 July 2011 -
Reviewed
13 July 2011
