What is it:

  • Calcified lymphadenopathy refers to the enlargement of lymph nodes in which there is the presence of calcification.
  • The calcification can be recognized on imaging as areas of very dense  foci  within the lymph nodes.
  • The causes of calcified lymphadenopathy are often
    • benign but
    • can sometimes be associated with
      • malignancy or
      • other diseases.

AKA:

  • Calcified Lymph Nodes or Calcified Lymphadenopathy

Abbreviation:

  • CL (Calcified Lymphadenopathy)

How does it appear on each relevant imaging modality:

Chest X-ray:

  • Parts:
    • Lymph nodes with calcification appear as dense, white areas on X-ray.
  • Size:
    • The size of calcified lymph nodes can vary but often appear as smaller, well-defined structures in the mediastinum or hilum.
  • Shape:
    • Calcified nodes are typically round or oval, though the calcification may cause some nodes to have irregular borders.
  • Position:
    • Commonly seen in the
      • mediastinum
      • hilar, and
      • supraclavicular regions.
  • Character:
    • Calcified lymph nodes are typically
      • well-defined and may have a
      • central or
      • eggshell appearance.

CT Scan:

  • Parts:
    • Lymph nodes appear as calcified  areas of
    • dystrophic calcium.
  • Size:
    • Nodes can be of various sizes, but those with extensive calcification are typically easier to identify.
  • Shape:
    • Calcified lymph nodes are
      • round or oval with
      • sharply defined borders.
  • Position:
    • Commonly seen in mediastinal, hilar, and supraclavicular regions.
  • Character:
    • Calcification in the lymph nodes may be:
      • Central calcification: Often seen in benign conditions such as
        • tuberculosis,
        • histoplasmosis, and
        • silicosis.
      • Eggshell calcification: A characteristic finding in sarcoidosis,
      • silicosis,
      • Psammomatous  calcification:  May be seen in
        • metastatic
          • papillary thyroid carcinoma
          • mucin secreting carcinomas

MRI:

  • Not utilized to evaluate calcifications but :
    • On MRI, calcified lymph nodes typically appear as
      • areas of
        • hypo-intensity in
          • T1 and
          • T2-weighted images

PET-CT:

  • Role:
    • PET-CT has limited utility in assessing calcified lymph nodes, as calcified nodes do not generally show increased glucose metabolism.

Differential diagnosis:

Infection:

  • Tuberculosis (TB):
    • Character: Granulomatous disease that can cause central calcification in lymph nodes.
    • Imaging Findings: Mediastinal or hilar lymph nodes with central calcification, often in the setting of prior infection.
  • Fungal infections (e.g., Histoplasmosis, Coccidioidomycosis):
    • Character: Granulomatous inflammation leading to calcified lymph nodes.
    • Imaging Findings: Calcified lymph nodes in the mediastinum or hilar region, often with a well-defined appearance.

Inflammation:

  • Sarcoidosis:
    • Character: A granulomatous disease that often results in eggshell calcification of lymph nodes.
    • Imaging Findings: Hilar and mediastinal lymph nodes with eggshell calcification, a hallmark of sarcoidosis.

Neoplasm (Benign or Malignant):

  • Lymphoma:
    • Character: Can result in calcified nodes due to necrosis or fibrotic changes.
    • Imaging Findings: Lymph nodes with central calcification, although more often non-calcified.
  • Metastatic Disease:
    • Character: Lymph node calcification in metastatic disease is usually peripheral and associated with specific malignancies like papillary thyroid carcinoma.
    • Imaging Findings: Peripheral calcification in mediastinal or supraclavicular nodes, possibly from a primary tumor like thyroid carcinoma.

Metabolic:

  • Amyloidosis:
    • Character: Rarely, amyloid deposition can cause calcification in lymph nodes.

Iatrogenic:

  • Post-radiation changes:
    • Character: Radiation therapy to the chest or mediastinum can cause lymph node calcification due to fibrosis or necrosis.
    • Imaging Findings: Calcified lymph nodes following radiation, often seen in patients treated for lung cancer or lymphoma.

Recommendations:

  • Not usually necessary but if malignant disease suspected .
    • Biopsy or fine needle aspiration (FNA) may be required if malignancy is suspected or the cause of calcification is unclear.

Laboratory testing:

  • Blood tests to evaluate fo
    • infections (e.g., CBC, tuberculin skin test), autoimmune markers (for sarcoidosis), or cancer screening (e.g., thyroid function tests).