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Lung diseases

Lymph Node More Pronounced

02/19/2007

Question:

I am a 45 year old male. Never a real smoker, but about 16 years ago I smoked for about 1 year (about a pack a day) and then quit. I smoked on and off very little in high school. Additionally, due to post nasal drip, I`ve had chronic bronchitis since I was a teenager so it is not uncommon for me to have a cough. Last week I developed a sore throat and a cold and as often happens it worked its way down into lungs causing a more acute form of my bronchitis (no fever but a very sharp and painful cough that was producing sputum) and almost a laryngitis type hoarseness. I went to my Dr. this week and they took a chest x-ray. The Dr. told me that while reviewing the x-ray, they compared it to another x-ray taken of my lungs back about 3 months ago (when I was there previously with a much lighter case of bronchitis than this time). According to my doctor, when they generally look at an x-ray of the lungs, they see a lot of small masses that are the lymph nodes. However, on the most recent x-ray, they noticed that one of those masses has become more pronounced. When I asked if she thought it got larger, she said again, "more pronounced". She did also begin the conversation by saying that she didn`t think there was anything to worry about, but to make sure they wanted me to have a CT with contrast done. They took blood tests and an EKG and said that everything looked normal. I`ve had no symptoms and have been relatively healthy ... I`m not sure whether this is something I should be worried about or whether the Dr. is just being thorough. When I had the first x-ray taken about 3 months ago, I didn`t really have an acute case of my bronchitis, it was the normal chronic one I deal with most of the time but I hadn`t had a chest x-ray for a while so I thought it would be a good idea to have one done. Therefore, I have the following questions :

1.) Do thoracic lymph nodes swell during acute bronchitis ? In other words, could the second x-ray have just caught the lymph node swollen because of the viral infection that caused my cold and the acute bronchitis ? And if that were the case, why wouldn`t the other lymph nodes have swollen too ?

2.) Is it possible that the most recent x-ray could have captured a slightly different angle of the lymph node making it seem more pronounced ?

3.) They also performed a CBC which they said was normal. If the mass were a tumor or lymph node growing due to something other than an infection, Wouldn`t something have shown up in my blood on my CBC ? (WBC, other chemicals).

4.) If the doctor is truly not concerned as she said, what are other possibilities of what this could be ?

Answer:

You have quite a few excellent but detailed questions.  I can try to answer the general points but without seeing the xrays and knowing the specific details of your medical history, it is not possible to provide you with specific answers.  I would strongly urge you to send your questions to your physician and then sit down with her to review the answers.

Just as there are lymph nodes under the chin and along the neck that drain the lymph fluid from the throat and upper airway, there are lymph nodes in the middle of the chest, around the great vessels and heart that drain the lymph fluid from the lungs.  There are multiple different locations for these lymph nodes (sometimes referred to as stations) and they are broadly classified as hilar and mediastinal.  These lymph nodes generally enlarge (due to increased numbers of inflammatory cells) with infections such as bronchitis or pneumonia but they can also enlarge with metastatic tumors.  In addition, benign (noncancerous) processes such as sarcoid can cause enlarge of these nodes.

Generally, a chest x-ray is a poor test to determine nodal enlargement within the chest.  A chest CT scan is a much more sensitive and specific imaging study.

Hopefully, this response will provide general answers to your questions and you can review more specific concerns with your regular physician who has seen the imaging studies and is more familiar with your complete medical history.

For more information:

Go to the Lung diseases health topic, where you can:

Response by:

Ralph   Panos, MD Ralph Panos, MD
Associate Professor
College of Medicine
University of Cincinnati