MEDIASTINAL LYMPH NODES
Last modified: September 7, 2025
Main references: ACR 2018, CAR 2025
Target population
Patients without a history of active neoplastic disease in the last 5 years
Absence of symptoms B
Additional Notes
In a study of 100 incidental mediastinal and hilar adenomegaly, lymph node size was the best indicator of etiology³
All adenomegaly < 15 mm was reactive (n=16)
All adenomegaly >25 mm was pathological (n=25)
Characteristics of benign lymph nodes
Well-defined contours
Homogeneous
Fatty hilum
Calcifications (except for neoplasia producing calcifications or ossifications - osteosarcoma, chondrosarcoma, papillary thyroid neoplasia, mucinous tumor, treated lymphoma).
Figures
Figure 1. Original 2018 ACR Summary Recommendations
References
Munden RF, Black WC, Hartman TE, MacMahon H, Ko JP, Dyer DS, et al. Managing Incidental Findings on Thoracic CT: Lung Findings. A White Paper of the ACR Incidental Findings Committee. Journal of the American College of Radiology. 2021 Sep;18(9):1267–79. doi:10.1016/j.jacr.2021.04.014
Bird JR, Brahm GL, Fung CI, Tu W, Zheng IJ, Kirkpatrick IDC. CAR Recommendations for the Management of Incidental Findings of the Spleen and Nodes in Adults. Canadian Association of Radiologists Journal. 2025;0(0). doi:10.1177/08465371251346732
Evison M, Crosbie PAJ, Morris J, Martin J, Barber PV, Booton R. A study of patients with isolated mediastinal and hilar lymphadenopathy undergoing EBUS-TBNA. BMJ Open Respiratory Research. 2014;1:e000040. doi:org/10.1136/bmjresp-2014-000040