The lymph nodes are an important part of the lymphatic system, which helps protect the body from disease-causing organisms, such as bacteria.

The lymph nodes sometimes swell when fighting an infection. Mediastinal lymphadenopathy is the medical term for swollen lymph nodes in the chest.

Usually, chest lymph nodes are too deep in the chest for a person to feel them. However, the nodes may cause pain when they swell. In most cases, swollen lymph nodes in the chest appear on an imaging scan such as a CT scan of the chest.

Along the collarbone, it may be possible for a person to feel swollen lymph nodes. These lymph nodes may swell when there is an infection, especially in nearby areas such as the breasts or throat.

Swollen lymph nodes can signal a serious underlying condition, such as cancer or an infection. Lymph nodes can also swell for no apparent reason.

In this article, we look at the possible causes of swollen lymph nodes in the chest and their treatments.

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The lymphatic system is part of the immune system, and it helps filter out harmful materials, such as infections or cancer cells. It includes a network of vessels, similar to blood vessels, connecting the many different lymph nodes.

These small nodes sometimes swell when the body is filtering out something harmful. They can also swell for no apparent reason, either because of chronic health issues or due to lymph node diseases, such as Kikuchi disease.

Swollen lymph nodes may occur in a single location or throughout the body. The site of the swelling often provides clues to the source of the problem.

For example, a person with a swollen lymph node in the neck might have a tooth abscess or strep throat.

Swollen lymph nodes in the chest often mean a person has a serious underlying medical condition. Some potential causes include:

  • Lung cancer: Swelling in the lymph nodes surrounding the lungs and in the chest may mean that a person has lung cancer or that lung cancer is spreading to other areas of the body.
  • Lymphoma: Lymphoma is a cancer of the lymph nodes. It can affect lymph nodes anywhere in the body and may begin in the chest or spread to the chest from other lymph nodes.
  • Sarcoidosis: Sarcoidosis is an inflammatory disease that can damage the lungs. A 2019 study found that it was one of the most common noncancerous reasons for swollen lymph nodes in the chest.
  • Tuberculosis: Tuberculosis is a serious infection that affects the lungs and may spread elsewhere in the body. It can cause swollen lymph nodes.
  • Other infections: Other infections, especially those that affect the lungs, may cause swollen lymph nodes. Examples include bacterial, viral, fungal, and parasitic infections, such as pneumonia, HIV, histoplasmosis, and toxoplasmosis, respectively. However, mononucleosis, a viral infection, rarely causes the lymph nodes in the chest to swell.
  • Other causes: Other serious health issues, such as heart failure or interstitial lung disease, can sometimes cause swollen chest lymph nodes.

In a 2019 study, of the 1,075 people who underwent an endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to diagnose swollen chest lymph nodes, cancer was the most common reason for the swollen chest lymph nodes, with 61.6% having some form of this disease.

Except for the lymph nodes above the collarbone, the lymph nodes in the chest are so deep that a person cannot feel them.

Most are located around organs and behind bones or other large structures. Many are behind the breastbone in the pleural space, which is the tissue lining the chest and surrounding the lungs.

Others surround the main veins and arteries of the heart. For example, the para-aortic lymph nodes lie on the front and the back of the ascending aorta and aortic arch.

As it is not possible to feel the lymph nodes deep in the chest by pushing on the skin, a person will require an imaging scan to determine whether they are swollen.

It is not possible to feel the mediastinal lymph nodes, which are deep in the chest. Other chest lymph nodes are also typically too deep to feel. Doctors usually only notice swelling in these lymph nodes on an imaging scan.

However, a person may feel some lymph nodes around the chest, such as the lymph nodes above the collarbone.

Swollen chest lymph nodes can cause symptoms such as chest pressure and fullness, so a doctor may suspect that either the lymph nodes are swollen or a person has an underlying disease.

People with swollen lymph nodes in the chest may also experience swollen lymph nodes elsewhere, such as in the armpits, groin, or neck.

People with swollen lymph nodes in the chest might not notice any symptoms. However, the swollen lymph nodes sometimes push on organs or other structures, which may cause pain.

An underlying illness can cause swollen lymph nodes along with other symptoms such as:

  • feeling sick or weak
  • fever
  • cough or trouble breathing
  • swollen lymph nodes elsewhere in the body
  • unexplained weight loss
  • night sweats
  • pressure in the chest

Lymphoma is a cancer in the lymphatic system or lymph nodes. It can begin in the lymph nodes of the chest or travel to these lymph nodes from other parts of the lymphatic system.

Other cancers, such as lung cancer, may also spread, affecting nearby lymph nodes.

Although a biopsy of the lymph nodes is the only way to diagnose cancer, a doctor may also recommend blood work and imaging scans to evaluate the source of the swollen chest lymph nodes.

The type of cancer a person has, where it began, and whether it has spread to other areas help determine the outlook. For instance, the overall 5-year relative survival rate for non-Hodgkin lymphoma is 72%.

The treatment for swollen chest lymph nodes depends on the cause. Some options include:

  • Infection treatment: Antibiotics can treat many infections, including tuberculosis. Fungal infections may require antifungal treatment, while some infections, such as viral pneumonia, respond well to supportive therapy. Supportive therapy means that a doctor monitors the person and treats their symptoms, such as with IV fluids and observation in the hospital.
  • Cancer treatment: The right cancer treatment depends on the cancer, but usually includes chemotherapy, radiation therapy, or both. A surgeon may remove the cancerous lymph nodes or recommend surgery to remove cancer in other areas of the body.
  • Immunosuppressive therapy: Treatment for an immune-mediated disease such as sarcoidosis includes corticosteroids and immune therapy.
  • Medication: As some medications can cause lymph nodes to swell, a doctor may recommend switching medications.

Finding swollen chest lymph nodes can be scary, especially if they accompany other symptoms. A doctor will perform other tests to determine the reason for the swelling and offer advice about treatment options.

Even a very serious diagnosis, such as cancer, often responds well to treatment, especially in the early stages. Furthermore, antibiotics can often completely cure infections, such as tuberculosis.

People who experience chest pain or pressure, breathing difficulties, or other symptoms of swollen chest lymph nodes should see a doctor as quickly as possible.

The doctor will likely ask for a log of all of the symptoms a person experiences, including when the symptoms first appeared. They will also ask the person about their medical history.