Enhancing thoracic lymphadenopathy: Uncommon etiologies but limited diagnostic considerations

Castleman disease (CD), also known as angiofollicular lymph-node hyperplasia, is a disease of unknown etiology that may present as either hyaline vascular (most cases) and plasma cell variants, often presenting as solitary lymph node enlargement. A multicentric form of CD has also been described and usually presents as multifocal disease involving superficial lymph node groups affecting older patients and often accompanied by systemic manifestations. On imaging studies, CD often presents as isolated lymph node enlargement, often showing intense enhancement on enhanced computed tomography. The pulmonary hilum and middle and posterior mediastinum are the most commonly affected sites within the thorax; anterior mediastinal involvement is less common. Localized CD is usually effectively treated with surgical resection. Patients are usually followed to detect disease recurrence or the development of associated conditions.