Mediastinal lymphadenopathy in COVID-19: A review of literature

Peripheral lymphadenopathy of unknown origin in adults: a diagnostic approach emphasizing the malignancy hypothesis

The term lymphadenopathy refers to an abnormality in size, consistency or morphological aspect of one or several lymph nodes. Although lymphadenopathies are commonly observed in everyday clinical practice, the difficulty of differentiating benign and malignant disease may delay therapeutic approaches. The present review aims to update diagnostic algorithms in different clinical situations based on the currently available literature. A literature review was performed to assess current knowledge of and to update the diagnostic approach. A short clinical vignette was used as an example of a typical clinical presentation. This case of metastatic lymphadenopathy with incomplete patient history demonstrates how misleading such lymphadenopathy may be, leading to a delayed diagnosis and even a fatal outcome. Any lymphadenopathy persisting for more than 2 weeks should be considered suspicious and deserves further investigation. Precise clinical examination, meticulous history-taking and a search for associated symptomatology are still cornerstones for diagnosing the origin of the condition. The next diagnostic step depends on the anatomical region and the specific patient's situation. Imaging starts with ultrasound, while computed tomography (CT) and magnetic resonance imaging (MRI) allow assessment of the surrounding structures. If the diagnosis remains uncertain, tissue sampling and histological analyses should be performed. Except for head and neck loco-regional lymphadenopathy, there are no methodical guidelines for persistent lymphadenopathy. The present review clarifies several confusing and complex situations. The accuracy of fine needle aspiration cytology could be increased by using core needle biopsy with immunocytologic and flow cytometric methods. Notably, except in the head and neck area, open biopsy remains the best option when lymphoma is suspected or when inconclusive results of previous fine needle aspiration cytology or core needle biopsy are obtained. The incidence of malignant lymphadenopathy varies with its location and the various diagnostic strategies. In metastatic lymphadenopathy of unknown primary origin, European Society for Medical Oncology (ESMO) guidelines and modern methods like next-generation sequencing (NGS) may help to manage such complex cases.

Presence of mediastinal lymphadenopathy in hospitalized Covid-19 patients in a tertiary care hospital in Pakistan-A cross-sectional study

BACKGROUND

The aim of this study was to investigate the presence of mediastinal lymphadenopathy in hospitalized Covid-19 patients in a tertiary care hospital in the metropolitan city of Lahore, Pakistan from September 2020 till July 2021.

METHODS

We retrospectively collected data of Covid-19 patients hospitalized from September 2020 till July 2021. Only those patients who tested PCR positive through a nasopharyngeal swab, were enrolled in the study. Patients' whose data were missing were excluded from this study. Our exclusion criteria included patients who tested negative on Covid-19 PCR, patients with comorbidities that may cause enlarged mediastinal lymphadenopathies such as haemophagocytic lymphohistiocytosis, neoplasia, tuberculosis, sarcoidosis or a systemic disease. The extent of lung involvement in Covid-19 patients was quantified by using a 25-point visual quantitative assessment called the Chest Computed Tomography Score. This score was then correlated with the presence of mediastinal lymphadenopathy.

FINDINGS

Of the 210 hospitalized patients included in the study, 131 (62.4%) had mediastinal lymphadenopathy. The mean and median Severity Score of Covid-19 patients with mediastinal lymphadenopathy (mean: 17.1, SD:5.7; median: 17, IQR: 13-23) were higher as compared to those without mediastinal lymphadenopathy (mean: 12.3, SD:5.4; median: 12, IQR:9-16).

INTERPRETATION

Our study documents a high prevalence of mediastinal lymphadenopathy in hospitalized patients with Covid-19 with the severity score being higher in its presence representing a more severe course of disease.

Mediastinal lymph node enlargement in COVID-19: Relationships with mortality and CT findings

BACKGROUND

The presence of mediastinal lymph node enlargement (MLNE) in computed tomography (CT) of Coronavirus disease 2019 (COVID-19) patients can be associated with disease severity.

OBJECTIVES

To investigate the relationship between MLNE with intensive care unit admission (ICU), mortality rates, and CT findings, especially in early-stage COVID-19 patients.

METHODS

This single-center retrospective case-control study, included aged ≥18 years, 250 COVID-19 patients with positive RT-PCR tests. We included two patient groups, 125/250 with and without MLNE. Demographic information of the patients, laboratory findings, length of stay in hospital or ICU, mortality rates, initial CT imaging findings and CT severity scores (CT-SS) were recorded and their relationship with MLNE was investigated.

RESULTS

Patients with MLNE were older (69.61 ± 11.16; p < 0.001) and had a higher CT-SS (14.67 ± 7.55; p < 0.001). There was a significant difference between the presence of MLNE with mortality (58/77, 75.3%; p < 0.001) and ICU admission (49/61, 80.3%; p < 0.001). Also, a statistical association was found between MLNE with ICU admission (p = 0.001) and (p < 0.001) mortality rates in patients with CORADS≤2 CT findings. In multivariate logistic regression analysis, MLNE was 8.8-fold (95% CI: 1.62-47.86, p =  0.01) more correlated with linear opacity and 0.25-fold with bronchial wall thickening (95% CI: 0.07-0.92, p =  0.04).

CONCLUSION

Mediastinal lymph node enlargement is an important CT finding that can predict the severe prognosis of COVID-19 patients. Even in patients without lung involvement on initial CT, the presence of MLNE should be carefully examined as it is associated with disease severity.

COVID-19: A systematic review and update on prevention, diagnosis, and treatment

Since the rapid onset of the COVID-19 or SARS-CoV-2 pandemic in the world in 2019, extensive studies have been conducted to unveil the behavior and emission pattern of the virus in order to determine the best ways to diagnosis of virus and thereof formulate effective drugs or vaccines to combat the disease. The emergence of novel diagnostic and therapeutic techniques considering the multiplicity of reports from one side and contradictions in assessments from the other side necessitates instantaneous updates on the progress of clinical investigations. There is also growing public anxiety from time to time mutation of COVID-19, as reflected in considerable mortality and transmission, respectively, from delta and Omicron variants. We comprehensively review and summarize different aspects of prevention, diagnosis, and treatment of COVID-19. First, biological characteristics of COVID-19 were explained from diagnosis standpoint. Thereafter, the preclinical animal models of COVID-19 were discussed to frame the symptoms and clinical effects of COVID-19 from patient to patient with treatment strategies and in-silico/computational biology. Finally, the opportunities and challenges of nanoscience/nanotechnology in identification, diagnosis, and treatment of COVID-19 were discussed. This review covers almost all SARS-CoV-2-related topics extensively to deepen the understanding of the latest achievements (last updated on January 11, 2022).