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Ann Thorac Surg 1989;48:247-250
© 1989 The Society of Thoracic Surgeons

Articles

Mediastinal lymph node necrosis: A newly recognized complication of mediastinoscopy

Roberta R. Miller, MD*, Bill Nelems, MD

Department of Pathology and Division of thoracic Surgery, Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia Canada

Accepted for publication February 24, 1989.

* Address reprint requests to Dr Miller, Department of Pathology, Vancouver General Hospital, 855 W 12th Ave, Vancouver, BC V5Z 1M9.

Eight cases of partial mediastinal lymph node necrosis identified at thoracotomy two to 17 days after cervical mediastinoscopy are described. In 6 cases, the involved nodes were grossly abnormal at operation, requiring frozen section interpretation. In the first 2 patients, the areas of nodal infarction were misinterpreted as necrotic tumor. Permanent sections from all 8 patients showed no evidence of tumor in the infarcted nodes. Factors predisposing to nodal infarction included right-sided tumor, central tumor, and large mediastinoscopic biopsy specimens. In all instances, the infarcted nodes were subcarinal and/or main bronchial. In 2 patients, left recurrent laryngeal nerve palsy occurred after mediastinoscopy. Necrosis in distal nodal areas should be recognized as a complication of thorough mediastinoscopic sampling, presumably due to interruption of arteries supplying these nodes. Awareness of this phenomenon by surgeons and pathologists may avert falsely positive gross or microscopic diagnoses of metastatic malignancy at thoracotomy.






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Copyright © 1989 by The Society of Thoracic Surgeons.