The number and size of normal mediastinal lymph nodes: a postmortem study

Abstract

For the CT diagnosis of pathologically enlarged nodes, information concerning the size of normal nodes is required. We studied 40 adult cadavers and determined the number and size of normal lymph nodes for each region of the mediastinum, counting all nodes and directly measuring the short and long diameters of each in the transverse plane of the node. The location of each node was classified according to the American Thoracic Society system, and the range and standard maximum sizes of normal lymph nodes in each location were determined. Nodes were found in 90-100% of cadavers in regions 4, 7, and 10; and in 68-85% of cadavers in regions 2 and 6. The average number of lymph nodes found was 3.5-4.8 in regions 4, 6, and 10R; 2.1-2.9 in regions 2, 7, and 10L; and 0.1-1.2 in all other regions. The mean short transverse diameters ranged from 2.4 to 5.6 mm, and the mean long transverse diameters ranged from 3.9 to 10.0 mm. The largest mean short and long transverse diameters were found in region 7, the next largest were in region 10R, followed by regions 4, 5, and 10L. We noted a different maximum normal size of lymph nodes in each region of the mediastinum. The short transverse diameter, which showed a smaller variation, appeared to be a more useful parameter than the long transverse diameter. We propose a standard for maximum normal short transverse diameters for nodes in each region of the mediastinum as follows: 12 mm for nodes in region 7; 10 mm for nodes in regions 4 and 10R; and 8 mm for nodes in other regions. The maximum long transverse diameters showed a wider variation, ranging from 25 to 10 mm.