Cancer Lymphoma Diagnosis Mediastinal Lymphadenopathy Why the Lymph Nodes in Your Chest Might Be Enlarged By Indranil Mallick, MD Indranil Mallick, MD LinkedIn Twitter Indranil Mallick, MD, DNB, is a radiation oncologist with a special interest in lymphoma. Learn about our editorial process Updated on September 01, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Doru Paul, MD Medically reviewed by Doru Paul, MD Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center. Learn about our Medical Review Board Print Table of Contents View All Table of Contents Causes Diagnosis Risks of Cancer Variations in Lymphoma Mediastinal lymph nodes are lymph nodes located in the mediastinum. The mediastinum is the area located between the lungs which contains the heart, esophagus, trachea, cardiac nerves, thymus gland, and lymph nodes of the central chest. The enlargement of lymph nodes is referred to as lymphadenopathy. Mediastinal lymphadenopathy generally suggests a problem related to lungs, whether benign or malignant. Verywell / Joshua Seong Causes There can be many different reasons why mediastinal lymph nodes become enlarged. The most common causes include: Acute lymphoblastic leukemia Anthracosis ("miner's lung") Chronic obstructive pulmonary disease (COPD) Coccidioidomycosis Cystic fibrosis Esophageal cancer Histoplasmosis Lung cancer Lymphoma Sarcoidosis Tuberculosis From a global perspective, mediastinal lymphadenopathy is primarily associated with tuberculosis given the high rate of infection (10 million per year). In the United States, it is most commonly associated with lung cancer and COPD. Diagnosis If the cause of the mediastinal lymphadenopathy is uncertain, your healthcare provider may order a procedure known as mediastinoscopy with biopsy. This involves a small surgical cut made just above the sternum or breastbone. A fiber-optic instrument called a mediastinoscope is then inserted through the incision and passed into the mid-part of the chest to obtain a sample of one or several lymph nodes. The procedure is performed in a hospital under general anesthesia. The results are usually ready in five to seven days. A less invasive procedure is known as fine needle aspiration (FNA) in which a long needle is inserted through the chest cavity into a lymph node to extract cells. Investigating Cancer Lymph nodes are small structures located in clusters throughout the body through which toxins and pathogens can be filtered. Mediastinal lymph nodes are typically the first ones that cancer cells from the lungs will trap, providing healthcare providers the means to know if cancer is spreading. When the mediastinal lymph nodes are enlarged due to a malignancy, lung cancer and lymphoma are the two most likely causes. However, in some cases, the enlargement may not be related to a primary cancer of the lungs but rather to metastatic cancer that has spread from another part of the body to the lungs. In this instance, the lung malignancy would be considered secondary cancer. The location and number of affected lymph nodes are also central to the staging of cancer, a classification system that determines how advanced malignancy is, which treatments should be administered, and what outcomes can be expected. Significance in Lymphoma Lymphoma, a cancer of a type of white blood cells called lymphocytes, can be categorized as either Hodgkin lymphoma or non-Hodgkin lymphoma. Mediastinal lymphadenopathy is one of the ways to differentiate two diseases. Mediastinal lymphadenopathy occurs in over 85% of Hodgkin lymphoma (HL) cases compared to only 45% with non-Hodgkin lymphoma (NHL). Moreover, the pattern of enlargement tends to be orderly and progressive with HL and more scattershot with NHL. While chest imaging can identify suspicious-looking lymph nodes, a definitive diagnosis can only be made by biopsy. Frequently Asked Questions What is mediastinal lymphadenopathy? Mediastinal lymphadenopathy is the swelling of lymph nodes in the chest, specifically the mediastinum (the area between the lungs containing the heart, trachea, and esophagus). Mediastinal lymphadenopathy is a sign of an underlying disease or infection. What are symptoms of mediastinal lymphadenopathy? Because mediastinal lymph nodes are inside the chest cavity, they are usually only observed on imaging tests. With that said, enlarged lymph nodes can sometimes compress structures within the chest and cause coughing, shortness of breath, wheezing, and problems swallowing. Learn More: What Swollen Lymph Nodes in Armpits Mean What causes mediastinal lymphadenopathy? There are many causes of mediastinal lymphadenopathy, some of which involve the lung and others that affect the body as a whole. Some of the more common include:Acute lymphoblastic leukemia (ALL)Cancer metastasisCoccidioidomycosisChronic obstructive pulmonary disease (COPD)Cystic fibrosis (CF)Esophageal cancerHistoplasmosisHypersensitivity pneumonitisLung cancerLymphomaSarcoidosisTuberculosis (TB) How is mediastinal lymphadenopathy diagnosed? If cancer is suspected, a fiber-optic scope (called a mediastinoscope) can be inserted through the chest wall to view the lymph nodes and obtain a biopsy. Diagnostic imaging of the lymph nodes with computed tomography (CT) and positron emission tomography (PET) can also help differentiate cancer from other diseases. Learn More: Facts About Lymph Nodes and Cancer How is mediastinal lymphadenopathy treated? Mediastinal lymphadenopathy may not be treated per se since it is ultimately the result of an underlying disease or infection. Treating the underlying cause will usually resolve the condition. However, with diseases like non-small cell lung cancer, the dissection (removal) of mediastinal lymph nodes is linked to improved survival times. Learn More: How Non-Small Cell Lung Cancer Is Treated Was this page helpful? Thanks for your feedback! Limiting processed foods and red meats can help ward off cancer risk. These recipes focus on antioxidant-rich foods to better protect you and your loved ones. Sign up and get your guide! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 8 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Piccaluga PP, Agostinelli C, Gazzola A, et al. "Pathobiology of Hodgkin Lymphoma." Adv Hematol. 2011;2011:920898. doi: 10.1155/2011/920898. 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PET and CT features differentiating infectious/inflammatory from malignant mediastinal lymphadenopathy: a correlated study with endobronchial ultrasound-guided transbronchial needle aspiration. Radiol Infect Dis. 2018 Mar;5(1):7–13. doi:10.1016/j.jrid.2018.01.002 American Cancer Society. Treatment choices for non-small cell lung cancer, by stage. Updated April 18, 2019.