Mediastinal lymphadenopathy, a review of nodal anatomy, pathology and sampling techniques

Mediastinal lymphadenopathy can be caused by benign and malignant disease. Understanding of the lymph node anatomy and stations is important for diagnosis, treatment and disease monitoring. Various imaging techniques can be used for the assessment of the mediastinum: ■ Chest radiography. ■ CT and fludeoxyglucose–positron emission tomography CT imaging. ■ Mediastinoscopy and mediastinotomy. ■ Endoscopic ultrasound (EUS). ■ Endobronchial ultrasound (EBUS). ■ MRI. Lymph node sampling is an important step in diagnosis of benign and malignant disease. More frequently, less invasive techniques such as EUS and EBUS are preferred to more invasive surgical techniques such as mediastinotomy, as they achieve similar results with fewer complications. Mediastinal lymphadenopathy can have important implications, yet, it is not an uncommon finding in routine imaging work. Causes for lymphadenopathy range from benign infections to malignant processes. In this review, we discuss the lymph node anatomy in the mediastinum, common pathologies causing lymphadenopathy and sampling techniques such as endobronchial ultrasound and endoscopic ultrasound.