Mediastinal lymphadenopathy in patients with severe COVID-19
Authors: Xavier Valette, Damien du Cheyron, Suzanne Goursaud
Journal: The Lancet Infectious Diseases (2020)

CT has a leading place in the management of patients with coronavirus disease 2019 (COVID-19). Mediastinal lymph node enlargement is not considered a typical CT feature of COVID-19, and only 6% of patients admitted to hospital for COVID-19 had lymphadenopathy.1Shi H Han X Jiang N et al.Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study.Lancet Infect Dis. 2020; 20: 425-434Summary Full Text Full Text PDF PubMed Scopus (2576) Google Scholar This observation is concordant with previous studies in Chinese populations.2Huang C Wang Y Li X et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; 395: 497-506Summary Full Text Full Text PDF PubMed Scopus (32878) Google Scholar, 3Chen N Zhou M Dong X et al.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.Lancet. 2020; 395: 507-513Summary Full Text Full Text PDF PubMed Scopus (14366) Google Scholar However, our experience in critically ill patients with COVID-19 in France seems to be different. 15 patients with positive RT-PCR for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were admitted to our intensive care unit (ICU) for acute respiratory failure on March 27, 2020. Among them, nine patients were under invasive mechanical ventilation and one patient was also under extracorporeal membrane oxygenation, whereas two patients were under high-flow nasal canula oxygenation. CT examination was performed in nine patients, with typical ground-glass opacities, reticulation, or consolidation features observed in all patients, as described in a recent expert consensus statement on chest CT findings related to COVID-19.4Simpson S Kay FU Abbara S et al.Radiological Society of North America expert consensus statement on reporting chest CT findings related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA.Radiol Cardiothorac Imag. 2020; (published online March 25.)DOI:10.1148/ryct.2020200152Crossref Scopus (482) Google Scholar The median number of days between onset of symptoms and CT scans was 7 days (IQR 6–8). Lymphadenopathies greater than 10 mm in the short axis were observed in six (66%) of the nine patients. Notably, several patients had voluminous lymphadenopathies, particularly in the subcarinal location, measuring up to 30 mm in the short axis (appendix). Invasive microbiological samples were assessed to rule out bacterial or fungal coinfection in all patients. Similarly, no patient had any haemophagocytic lymphohistiocytosis, neoplasia, or systemic disease. Thus, lymphadenopathy was more common in our French cohort of ICU patients than previously reported. To our knowledge, highly enlarged mediastinal lymph nodes have not been described in patients with COVID-19. Most reports were not specifically concerning critically ill patients, so disease severity could probably explain this discrepancy, as suggested by Li and colleagues.5Li K Wu J Wu F et al.The clinical and chest CT features associated with severe and critical COVID-19 pneumonia.Invest Radiol. 2020; (published online Feb 29.)DOI:10.1097/RLI.0000000000000672Crossref Scopus (830) Google Scholar Further studies are needed to better characterise the CT features of patients with COVID-19, in order to establish a possible link between the presence of specific radiological signs and the severity of the disease. Pending such studies, lymphadenopathy should not be considered an atypical feature of COVID-19, especially when we have seen that mediastinal lymph nodes are very large in our critically ill patients. We declare no competing interests. Download .pdf (.28 MB) Help with pdf files Supplementary appendix Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive studyCOVID-19 pneumonia manifests with chest CT imaging abnormalities, even in asymptomatic patients, with rapid evolution from focal unilateral to diffuse bilateral ground-glass opacities that progressed to or co-existed with consolidations within 1–3 weeks. Combining assessment of imaging features with clinical and laboratory findings could facilitate early diagnosis of COVID-19 pneumonia. Full-Text PDF