Cardiophrenic angle adenopathy: update of causes and significance

Our plain-English summary of Cardiophrenic angle adenopathy: update of causes and significance, by P. Vock, J. Hodler (Radiology, 1986).

The study

• Authors: P. Vock, J. Hodler
• Journal: Radiology
• Published: 1986;159(2):395-9
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Of 21 cases of cardiophrenic angle adenopathy (CAA) detected on computed tomography (CT) examination, 12 were due to malignant lymphomas, seven to carcinomas, and two to mesotheliomas. Of the nine lesions that were not malignant lymphomas, four were of supradiaphragmatic and five of infradiaphragmatic origin. On average, CAA was detected 4.6 years after the primary neoplasm was diagnosed. Only 29% of the patients were alive 14 months after CAA was detected on CT scans. Radiography was inferior to CT in the detection of CAA, with only 35% of radiography results clearly positive. Malignant lymphoma is a major but not exclusive cause of CAA, and it must be differentiated from lymphatic seeding of supradiaphragmatic and infradiaphragmatic malignancies. Unilateral CAA may point to supradiaphragmatic neoplasms or, if right-sided, to ovarian carcinoma, and bilateral CAA may indicate another neoplasm of infradiaphragmatic origin.

In plain English

This retrospective study from University Hospital, Bern, Switzerland, reviewed 21 cases of cardiophrenic angle adenopathy (enlarged lymph nodes in the lower chest beside the heart and diaphragm) found on CT scans from 1980 to 1984. Ten cases were due to Hodgkin lymphoma, two to non-Hodgkin lymphoma, seven to carcinomas (three of them ovarian cancers) and two to mesothelioma, one pleural and one peritoneal. The article does not mention asbestos. On average the enlarged nodes were found 4.6 years after the original tumor was diagnosed. Fifteen patients (71%) died during a mean follow-up of 14 months. Chest X-rays, available for 17 patients, were positive in six (35%), all with nodes at least 3 cm across, and negative in eight (47%). The authors could not verify a benign cause in any case. They concluded that these enlarged nodes are not limited to malignant lymphoma and that one-year survival is poor, though some patients with Hodgkin disease may have a better prognosis. They noted that their patient population was small and that they could not state how common the finding is.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective case series of CT findings, with a reference review of 100 normal chest CT scans
• Who was studied: 21 patients with cardiophrenic angle adenopathy detected on CT from 1980 to 1984 at University Hospital, Bern, Switzerland. The scans were done to detect tumors or to stage known cancers. Mean age was 47 years. In addition, 100 consecutive chest CT scans previously read as normal were reviewed for comparison.
• Exposure: Not applicable. The study examined which primary tumors caused the enlarged nodes. It does not discuss asbestos or any other exposure.
• Main results:
  • Of the 21 cases, 10 were due to Hodgkin lymphoma, 2 to non-Hodgkin lymphoma and 7 to carcinoma.
  • Two cases were due to mesothelioma: one pleural and one peritoneal.
  • Across all 21 patients, the average time from tumor diagnosis to detection of the enlarged nodes was 4.6 years (range 0 to 21 years).
  • 15 patients (71%) died during a mean follow-up of 14 months. Their average time from detection to death was 10 months (range 0 to 22 months).
  • Of 17 patients with chest radiographs, the X-ray was positive in 6 (35%), all with nodes of at least 3 cm. It was questionable in 3 and negative even on retrospective review in 8 (47%).
  • When the enlarged nodes were on one side only, they were on the same side as the tumor in patients with chest tumors and on the right in patients with ovarian cancer.
  • The authors could not verify a benign cause of the enlarged nodes in any case.
• The authors' conclusion: The authors concluded that sharply defined cardiophrenic nodules of at least 10 mm suggest adenopathy that is not necessarily limited to malignant lymphoma. They also concluded that one-year survival is poor in these patients, though some with Hodgkin disease may have a better prognosis.
• Limitations the authors state:
  • The patient population was small.
  • The authors could not state how common the finding is, because the cardiophrenic area is not systematically checked on abdominal CT.
  • Verification, even by radiologic follow-up, is often not obtained because of terminal disease.

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Mesothelioma, Neoplasm, CT Scan, Bilateral.

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