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Arquivos Brasileiros de Cardiologia

Print version ISSN 0066-782X

Arq. Bras. Cardiol. vol.98 no.5 São Paulo May 2012

http://dx.doi.org/10.1590/S0066-782X2012000500017 

CASE REPORT

 

Transient lymphadenopathy secondary to nephrotic syndrome

 

 

Olívia Meira Dias; André Nathan Costa; Carlos Roberto Ribeiro Carvalho; Ronaldo Adib Kairalla

Instituto do Coração (Incor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil

Correspondence

 

 


ABSTRACT

Mediastinal lymphadenomegaly secondary to hypervolemia is an underdiagnosed tomographic finding. Herein we describe, in a patient with normal cardiac function, findings of pulmonary congestion associated to lymph node enlargement. The nephrotic syndrome causing hypoalbuminemia, low plasma colloid osmotic pressure and augmented transcapillary fluid leakage was the probable cause of the radiological findings.

Keywords: Scleroderma, systemic; lymphoma; mediastinum; nephrotic syndrome.


 

 

A 57-year-old man with systemic scleroderma and occupational silica exposure presented a two-month history of progressive dyspnea and peripheral edema. Physical examination revealed anasarca, pulmonary bibasilar crackles and hypoxemia (SatpO2 80%).

Contrasted high-resolution computed tomography scan (HRCT) of the chest revealed enlarged mediastinal lymph nodes and mediastinal fat associated to bilateral diffuse ground-glass infiltrates and interlobular septal thickening with predominance in the superior lobes, without arterial thrombi. The echocardiogram was unremarkable, and renal biopsy was diagnostic of nephrotic syndrome secondary to focal segmental glomerulosclerosis.

After prednisone and treatment with diuretics, the edema and dyspnea significantly improved. HRCT performed two months later showed resolution of the signs of pulmonary congestion and involution of mediastinal lymph node and fat enlargement (Figure 1).

Mediastinal lymphadenomegaly secondary to hypervolemia is an underdiagnosed tomographic finding1-9. Its incidence may arise in 55% of patients with symptomatic congestive heart failure1. They are usually located in the pretracheal area and have < 2 cm in short axis diameter10. Differential diagnosis to this case would include malignancies, lymphoma and sarcoidosis.

In this study, we describe a patient with normal cardiac function, findings of pulmonary congestion associated to lymph node enlargement. The nephrotic syndrome causing hypoalbuminemia, low plasma colloid osmotic pressure and augmented transcapillary fluid leakage was the probable cause of the radiological findings. To our surprise, even lymph nodes with peripheral calcification can enlarge due to edema. The rapid improvement after treatment, together with resolution of parenchyma findings of congestion, leads us to the diagnosis without an invasive procedure.

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Sources of Funding

There were no external funding sources for this study.

Study Association

This study is not associated with any post-graduation program.

 

References

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10. Pastis NJ Jr, Van Bakel AB, Brand TM, Ravenel JG, Gilbert GE, Silvestri GA, et al. Mediastinal lymphadenopathy in patients undergoing cardiac transplant evaluation. Chest. 2011;139(6):1451-7.         [ Links ]

 

 

Correspondence:
Olívia Meira Dias
Rua Capote Valente, 671 / 1401, Pinheiros
05409-002 - São Paulo, SP, Brazil
E-mail: meiradias@yahoo.com.br

Manuscript received May 29, 2011
Revised manuscript received July 13, 2011
Accepted July 28, 2011.

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