Hilar lymphadenopathy, a novel finding in the setting of coronavirus disease (COVID-19): a case report

Abstract

Background: As the outbreak of coronavirus disease 2019 (COVID-19) has progressed, computed tomography has emerged as an integral part of the diagnosis alongside reverse transcriptase-polymerase chain reaction assays. Frequently encountered imaging findings include peripheral airspace consolidations; bilateral ground-glass opacities; and, less commonly, cavitation. Hilar lymphadenopathy is a rarely reported finding in the setting of COVID-19. Case presentation: A 73-year-old Caucasian woman presented to our hospital with fever and fatigue. She had a maximum body temperature of 102.3°F with lymphopenia and thrombocytopenia. She was diagnosed with severe acute respiratory syndrome coronavirus 2 infection on the basis of a positive result from a reverse transcriptasepolymerase chain reaction of a nasopharyngeal swab sample. Contrast-enhanced chest computed tomography revealed multifocal, subpleural ground-glass opacities with nodular consolidations bilaterally. Computed tomography also demonstrated atypical bilateral hilar lymphadenopathy, a rarely reported imaging feature of COVID-19. Chest computed tomography 1 month before the presentation did not show focal consolidations or lymphadenopathy. This indicated that the findings were due to the patient's severe acute respiratory syndrome coronavirus 2 infection. She received 5 days of oral hydroxychloroquine and experienced resolution of her symptoms. Conclusion: Chest computed tomography has been used extensively to diagnose and characterize the distinguishing radiological findings associated with viral pneumonia. It has emerged as an integral part of the diagnosis of COVID-19 alongside reverse transcriptase-polymerase chain reaction assays. Clinicians must be aware of uncommon clinical and radiological findings in order to diagnose this entity. Hilar lymphadenopathy is commonly seen with fungal infections, mycobacterial infections, and sarcoidosis. An extensive literature review found that bilateral hilar lymphadenopathy has not been reported in the setting of COVID-19. More data are needed to establish the clinical impact of this novel finding.

Spectrum of atypical pulmonary manifestations of COVID-19 on computed tomography

“…The incidence of hilar lymphadenopathy in our study was 0.6%. In the available current literature, only one case report with hilar lymphadenopathy has been reported in COVID-19 [ 39 ]. Few studies showed no presence of hilar lymphadenopathy in COVID-19 [ 21 , 40 ].…”

“…Mediastinal lymphadenopathy previously thought to be an atypical feature has been redefined as “not-atypical” feature of COVID-19 [ 7 , 41 ]. However, hilar lymphadenopathy which is usually associated with fungal infections, mycobacterial infections, and sarcoidosis are seldom seen in COVID pneumonia [ 39 ]. Histopathological correlation was unavailable for our cases.…”

Cervical and Preauricular Lymphadenopathies as Atypical Manifestations in the Setting of COVID-19: A Case Report

“…Similarly, the report of the mediastinal LA in 15 COVID-19 patients admitted to the intensive care unit has also been described following the chest CT scan diagnosis in France [ 26 ]. Hilar LA is regularly observed during sarcoidosis, fungal and mycobacterial infections [ 27 ]. However, according to the recent report from the US Monmouth Medical Center, a 73-year-old Caucasian woman with typical symptoms of COVID-19 was diagnosed as an infected patient upon determining the positive result of the RT-PCR test.…”

“…However, according to the recent report from the US Monmouth Medical Center, a 73-year-old Caucasian woman with typical symptoms of COVID-19 was diagnosed as an infected patient upon determining the positive result of the RT-PCR test. Notably, chest CT scan examination also displayed an atypical bilateral hilar LA, as well as focal consolidations, besides the multifocal subpleural ground-glass opacities [ 27 ].…”

Diffuse Lymphadenopathy Syndrome as a Flare-Up Manifestation in Lupus and Mixed Connective Tissue Disease Following Mild COVID-19

“…COVID-19 manifestations are polymorphic and highly variable, both clinically and radiologically. Clinical presentations include DL involving cervical, subcarinal, and superior-mediastinal lymph nodes, mainly in severe COVID-19 cases [ 1 , 2 ]. Other reports show multiple cervical lymphadenopathies during the symptomatic phase of the disease [ 3 , 4 ].…”