1
Q
A
2
Q
The International Thymic Malignancy Interest Group advocated for a three-compartment mediastinal division scheme based on what type of imaging?
A
The division scheme is based on axial computed tomography (CT) images.
3
Q
What are the names of the three mediastinal compartments in the CT-based model?
A
Prevascular (anterior), visceral (middle), and paravertebral (posterior).
4
Q
The prevascular, or anterior, mediastinal compartment consists of everything anterior to the _____.
A
pericardium
5
Q
The visceral, or middle, mediastinum contains the heart, pericardium, aortic arch, trachea, and what major veins?
A
It contains the innominate veins and superior vena cava (SVC).
6
Q
What is the posterior boundary of the middle (visceral) mediastinum on a CT scan?
A
A vertical line connecting a point on each thoracic vertebral body at 1 cm posterior to its anterior margin.
7
Q
What condition is characterized by dilation of collateral veins in the upper thorax and neck, and edema and plethora of the face, neck, and upper torso due to extrinsic compression?
A
Superior vena cava (SVC) syndrome.
8
Q
What are the two most common malignant etiologies of Superior Vena Cava (SVC) syndrome?
A
Bronchogenic carcinoma and lymphoma.
9
Q
Hoarseness in the context of mediastinal disease may result from compression or invasion of which nerve?
A
The recurrent laryngeal nerve.
10
Q
Thymomas are classically associated with what autoimmune disorder?
A
Myasthenia gravis.
11
Q
On a CT scan, mediastinal lymph nodes are considered abnormally enlarged if they are greater than what diameter in the short axis?
A
Greater than 1 cm in diameter in the short axis.
12
Q
The presence of fat density within a mediastinal mass on CT could suggest etiologies like a lipoma, thymolipoma, or _____.
A
teratoma
13
Q
What nuclear imaging technique relies on probes like 18F-fluorodeoxyglucose (FDG) which are trapped in metabolically active neoplastic cells?
A
Positron Emission Tomography (PET).
14
Q
What is a significant limitation of PET scanning in distinguishing benign from malignant thymic masses?
A
Most thymomas have low FDG uptake due to their relatively indolent nature.
15
Q
Radioiodine scanning is pathognomonic for what condition when a positive result is found in the mediastinum?
A
Ectopic thyroid tissue.
16
Q
What is the name of the minimally invasive procedure that uses a bronchoscope with an ultrasound probe to perform transbronchial needle aspiration of mediastinal tumors adjacent to the airways?
A
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).
17
Q
EBUS-TBNA is useful in diagnosing sarcoidosis manifesting as mediastinal adenopathy, obviating the need for a more invasive _____.
A
surgical mediastinoscopy
18
Q
What is a major limitation of EBUS-TBNA in the initial diagnosis of lymphoma, particularly Hodgkin lymphoma?
A
The amount of tissue provided may be inadequate for histologic subtyping.
19
Q
What biopsy technique, similar to EBUS-TBNA, uses a gastroscope to sample mediastinal nodes, particularly in the posterior subcarinal region?
A
Endoscopic ultrasound (EUS)–guided sampling.
20
Q
Transthoracic needle aspiration is most commonly performed under CT guidance for masses in which mediastinal compartment?
A
The anterior compartment.
21
Q
What surgical procedure provides direct access to the paratracheal and subcarinal lymph nodes for biopsy?
A
Cervical mediastinoscopy.
22
Q
The surgical procedure known as an anterior mediastinotomy, or the _____ procedure, provides access to lymph nodes in the aortopulmonary window.
A
Chamberlain
23
Q
What is the term for the normal enlargement of thymic tissue that can occur following chemotherapy for lymphoma, mimicking disease recurrence?
A
Thymic rebound.
24
Q
Extragonadal germ cell tumors (GCTs) found in the mediastinum are classified into what three groups?
A
Teratoma, seminoma, and nonseminomatous GCT.
25
A _____ is a type of teratoma that contains only the epidermis and its derivatives.
dermoid cyst
26
The rare symptom of expectorating hair, known as _____, can occur if a teratoma erodes into a bronchus.
trichoptysis
27
On a CT scan, the presence of fat, calcium, and soft tissue within an anterior mediastinal mass is most consistent with what diagnosis?
Teratoma.
28
For practical purposes, lymphomas are broadly classified into non-Hodgkin lymphoma (NHL) and _____.
Hodgkin lymphoma (HL)
29
What rare subset of non-Hodgkin lymphoma arises from thymic B cell precursors and typically affects young adult females?
Primary mediastinal B cell lymphoma (PMBCL).
30
A B cell lymphoma that exhibits histologic features of both PMBCL and classic nodular sclerosing HL is termed a _____.
mediastinal gray zone lymphoma
31
The management of lymphoma is distinguished from other mediastinal lesions because it is primarily _____ and not surgical.
medical
32
The rare and highly aggressive NUT carcinoma is characterized by a specific genetic translocation, t(15;19), resulting in what fusion oncogene?
BRD4-NUT (nuclear protein in testis) fusion oncogene.
33
A mass-like lesion formed by an aggregation of caseous lymph nodes due to prior exposure to histoplasma or tuberculosis is called a _____.
mediastinal granuloma
34
What type of developmental cyst, usually located in the middle mediastinum, is lined with respiratory epithelium?
Bronchogenic cyst.
35
What is the most common type of tumor found in the posterior mediastinum?
Neurogenic tumors.
36
Neurogenic tumors arising from sympathetic ganglia, such as _____, often elaborate endocrine peptides and catecholamines.
neuroblastoma
37
What nuclear imaging technique is specifically used for the detection of neuroblastic tumors like neuroblastoma?
I-meta-iodobenzylguanidine (MIBG) scintigraphy.
38
What is the most common cause of acute mediastinitis, historically represented by Boerhaave syndrome?
Spontaneous rupture of the esophagus.
39
The classic Boerhaave syndrome involves forceful vomiting followed by immediate, unrelenting _____ chest pain.
retrosternal
40
What is Mackler's triad, a classic but infrequently observed sign of esophageal rupture?
Chest pain, vomiting, and subcutaneous emphysema.
41
In suspected esophageal injury, what imaging study should be pursued to confirm perforation or rupture by observing contrast extravasation?
Contrast esophagography.
42
Why is Gastrografin (a water-soluble agent) often preferred over barium for an initial esophagram when esophageal perforation is suspected?
There is concern that extravasated barium could induce further inflammation.
43
What is the most sensitive single imaging study for detecting mediastinitis of any origin?
Chest CT.
44
In Boerhaave syndrome, rupture most commonly occurs along the _____ wall of the distal esophagus.
left posterolateral
45
What is the term for acute mediastinitis caused by the direct extension of an oropharyngeal or cervical infection through deep neck spaces?
Descending necrotizing mediastinitis.
46
In descending necrotizing mediastinitis, infection most commonly spreads into the posterior mediastinum via the '_____ space'.
danger
47
What are the two most common risk factors associated with developing mediastinitis after cardiac surgery?
Diabetes mellitus and obesity.
48
The use of topical nasal _____ is a recommended guideline to reduce Staphylococcus carriage and prevent post-sternotomy wound infections.
mupirocin
49
Inhalational anthrax, caused by _____, is characterized by hemorrhagic mediastinitis.
Bacillus anthracis
50
In inhalational anthrax, spores are transported to hilar and mediastinal lymph nodes where the bacteria produce lethal factor and _____ factor, leading to necrosis and hemorrhage.
edema
51
In post-sternotomy mediastinitis, what are the two most frequently isolated bacterial species?
Staphylococcus epidermidis and Staphylococcus aureus.
52
What fungal genus is uncommonly recovered from mediastinal cultures following esophageal violation but is associated with mortality rates over 70%?
Candida species.
53
Fibrosing mediastinitis, mediastinal granuloma, and mediastinal adenitis are most commonly attributed to an aberrant immune response to what endemic fungus?
Histoplasma.
54
What is the key pathological difference between fibrosing mediastinitis (FM) and mediastinal granuloma (MG)?
FM is an invasive fibrotic mass, whereas MG is a non-invasive, encapsulated mass of caseous debris.
55
A key feature of Post-Histoplasma Fibrosing Mediastinitis (PHFM) is the _____ obstruction of pulmonary arteries or veins, SVC, or airways.
invasive
56
What is the prognosis for patients with fibrosing mediastinitis involving both lungs?
Bilateral involvement carries a very high mortality and is almost uniformly fatal.
57
What intervention may improve survival in patients with bilateral fibrosing mediastinitis by relieving vascular obstruction?
Vascular stenting.
58
What is the characteristic imaging finding of a late-stage mediastinal granuloma on CT?
Pathognomonic speckled, subcapsular, or uniform calcification.
59
A rare but serious complication of a mediastinal granuloma is when it attaches to and drains its contents into an adjacent structure, a process called _____.
fistulization
60
What is the most effective therapy for a symptomatic mediastinal granuloma?
Surgical drainage/resection.
61
What is the term for the syndrome of severe central chest pain, fever, and enlarged, non-calcified mediastinal lymph nodes, often due to acute Histoplasma infection?
Mediastinal adenitis.
62
On imaging, thymic carcinomas are described as _____ masses with areas of necrosis and calcifications, and they are highly FDG-avid on PET scan.
heterogenous
63
What is the mainstay of therapy for thymomas, providing the best chance for an optimal prognosis?
Surgical resection.
64
The clinical presentation of what type of tumor may include Cushing syndrome and association with multiple endocrine adenomatosis?
Carcinoid tumors arising in the thymus.
65
What are the two tumor markers often secreted by highly aggressive nonseminomatous germ cell tumors like embryonal cell carcinoma?
Human chorionic gonadotropin and alpha-fetoprotein.
66
Mediastinal germ cell tumors have been associated with Klinefelter syndrome and _____ malignancy.
hematologic
67
The chemotherapy regimen DA-EPOCH-R is gaining traction as a standard front-line therapy for PMBCL because it achieves high survival rates without the need for up-front _____.
radiation
68
The mediastinum is the most common site for ectopic parathyroid adenomas in cases of surgically resistant _____.
hyperparathyroidism
69
What is the most sensitive scanning technique for locating ectopic parathyroid tissue?
99m-technetium sestamibi scanning.
70
The presence of a unilateral paravertebral mass on a radiograph is the typical appearance of what class of tumors?
Neurogenic tumors.
71
What is the most common type of neurogenic tumor, which is incompletely encapsulated and may be a manifestation of neurofibromatosis?
Neurofibroma.
72
A schwannoma may extend into the intervertebral foramina, which is best visualized with what imaging modality?
Magnetic resonance imaging (MRI).
73
The triad of mediastinal widening, hemoconcentration, and altered mental status is characteristic of what disease?
Inhalational anthrax.
74
In the 2001 bioterrorism outbreak, what intervention, in addition to antibiotics, resulted in improved survival for patients with inhalational anthrax?
Aggressive drainage of mediastinal and pleural collections.
75
The microbiology of mediastinitis from esophageal perforation is often polymicrobial, with _____ species dominating among aerobic isolates.
Streptococcus
76
Unlike Post-Histoplasma Fibrosing Mediastinitis (PHFM), idiopathic fibrosing mediastinitis (IFM) is typically not _____ and may affect extrathoracic sites.
calcified
77
What is the likely explanation if a mediastinal granuloma shows a marked decrease in size and a reduction in its calcification burden on serial imaging?
Silent fistulization to the esophagus.
78
What are the superior and inferior boundaries for all mediastinal compartments?
The thoracic inlet superiorly and the diaphragm inferiorly.
79
Dyspnea from involvement of the _____ nerve can cause diaphragmatic paralysis in patients with mediastinal masses.
phrenic
80
In a study of mediastinal lesions, what imaging modality distinguished between malignant and benign lesions with 95% sensitivity and 87% specificity based on apparent diffusion coefficient levels?
Diffusion-weighted MRI.
81
What is the preferred sampling option for mediastinal lymphadenopathy when there is a high clinical suspicion of sarcoidosis or metastatic cancer?
EBUS-TBNA.
82
Patients with _____ tumors have a poorer prognosis, with 5-year survival of 50–77% and 10-year survival of 30–55%.
invasive
83
On CT scan, how does a thymoma typically distort the gland's normal shape compared to thymic hyperplasia?
Thymoma usually distorts the gland's shape asymmetrically and extends to one side.
84
What is the treatment of choice for thymic carcinoma, if possible?
Surgical resection.
85
Primary mediastinal B cell lymphoma (PMBCL) and classic nodular sclerosing Hodgkin lymphoma (HL) both arise from _____ precursors.
thymic B cell
86
Novel immune checkpoint inhibitors, such as pembrolizumab, have shown utility as salvage treatment for relapsed Hodgkin lymphoma (HL) and PMBCL because these tumors up-regulate immune checkpoint pathways that evade _____-_____ immune surveillance.
anti-tumor
87
What is the most common cyst found in infants and children, which may be associated with spinal extension and malformations?
Enteric cysts.
88
Malignant tumors of nerve sheath origin, such as malignant schwannoma, behave aggressively with both local invasion and distant metastasis, and half arise in patients with _____.
neurofibromatosis
89
In cases of esophageal rupture, mortality increases from 10-15% to 40-60% when intervention is delayed more than how long?
More than 24 hours.
90
Mediastinitis develops in approximately 0.09% of cases after what common diagnostic procedure involving needle passage through the airway wall?
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).
91
For postexposure prophylaxis to anthrax, ciprofloxacin or doxycycline is recommended along with immunization with _____ antibodies.
antitoxin
92
What is the recommended antibiotic for suspected inhalational anthrax, often given with a second agent like clindamycin?
Ciprofloxacin or doxycycline.
93
For a suspected mediastinal granuloma, what is the risk of performing an endobronchial ultrasound-guided biopsy?
Infection/superinfection of the granuloma, as immune surveillance may be poor within the lesion.
94
According to Table 115.1, what is the likely etiology of a bulky mass found on initial presentation in the anterior mediastinum?
The likely etiologies include lymphoma, germ cell tumor, thymic neoplasm, and metastatic disease.
95
On a chest CT, a bulky mass in the posterior mediastinum on initial presentation is characteristic of what type of tumor?
A bulky posterior mediastinal mass is characteristic of a neurogenic tumor.
96
A mass showing fat density on a chest CT scan suggests what likely etiologies according to Table 115.1?
Likely etiologies include mediastinal lipomatosis or lipoma, liposarcoma, thymolipoma, or teratoma.
97
What are the three likely etiologies for a mediastinal mass associated with a pleural effusion, as listed in Table 115.1?
Metastatic disease with pleural involvement, granulomatous inflammation of lymph nodes, or thymic neoplasms with 'drop' metastases.
98
Recent onset of superior vena cava obstruction seen on a chest CT suggests which four potential causes?
Bronchogenic carcinoma, lymphoma, catheter-associated thrombosis, or extrinsic compression.
99
What is the likely etiology for a long-standing superior vena cava obstruction observed on a chest CT?
Long-standing SVC obstruction is likely caused by fibrosing mediastinitis.
100
According to Table 115.1, erosion or destruction of bone seen with a mediastinal mass points to what group of likely etiologies?
Metastatic disease, discitis/osteomyelitis, arterial aneurysm, tumors of peripheral nerves or sympathetic ganglia, or meningocele.
101
What are the likely etiologies for a mediastinal mass that causes a spine or rib deformity?
An enteric cyst or neurofibromatosis.
102
What are the four major categories of tumors or cysts found in the anterior mediastinum, often remembered by the 'four Ts'?
Thymoma, Teratoma (and other germ cell tumors), Thyroid (goiter/neoplasm), and 'Terrible' lymphoma.
103
Benign teratomas, the most common type of mediastinal germ cell tumor, are composed of tissues originating from which germ cell layers?
Benign teratomas may contain structures originating in all three primary germ cell layers (ectoderm, mesoderm, endoderm), though ectodermal derivatives predominate.
104
What is the term for a teratoma-like lesion that contains only the epidermis and its derivatives?
A lesion containing only epidermis and its derivatives is referred to as a dermoid cyst.
105
What specific symptom might a patient exhibit if a mediastinal teratoma erodes into a bronchus?
The patient may have hemoptysis or even expectorate differentiated tissue such as hair (trichoptysis) or sebaceous material.
106
Thymic neoplasms, germ cell tumors, and lymphomas are characteristic lesions of which mediastinal compartment?
These are characteristic lesions of the anterior (prevascular) mediastinum.
107
What is the most common cause of masses in the middle (visceral) mediastinum?
Enlargement of lymph nodes (lymphadenopathy) from various causes.
108
Besides lymphadenopathy, what are two other common types of lesions found in the middle mediastinum?
Developmental cysts (such as pericardial and bronchogenic cysts) and lymphoma.
109
The vast majority of tumors in the posterior (paravertebral) mediastinum arise from what type of tissue?
The vast majority of posterior mediastinal tumors are neurogenic, arising from neural tissues.
110
What is the term for the clinical condition that can occur when a tumor, such as one in the middle mediastinum, compresses the thin-walled, low-pressure superior vena cava?
Superior vena cava (SVC) syndrome.
111
The ITMIG-advocated three-compartment division of the mediastinum is based on images from which modality?
This division scheme is based on axial computed tomography (CT) images.
112
The modern CT-based model divides the mediastinum into the prevascular, visceral, and _____ compartments.
paravertebral
113
The middle or visceral compartment of the mediastinum contains which major cardiovascular structures?
It contains the heart, pericardium, aortic arch and its branches, innominate veins, superior vena cava (SVC), and pulmonary arteries.
114
What is the most common etiology of superior vena cava (SVC) syndrome today?
Bronchogenic carcinoma and lymphoma are now the most common etiologies.
115
Involvement of the recurrent laryngeal nerve by a mediastinal mass can result in what clinical sign?
Hoarseness.
116
Thymomas are classically associated with which autoimmune disorder?
Myasthenia gravis.
117
PET imaging relies on the high metabolic activity of neoplastic cells to trap probes such as _____.
18F-fluorodeoxyglucose (FDG)
118
Which non-invasive biopsy technique is particularly useful for sampling mediastinal tumors or lymph nodes adjacent to the major airways?
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).
119
Which biopsy technique, similar to EBUS-TBNA, uses a gastroscope to access and sample posterior mediastinal and subcarinal nodes?
Endoscopic ultrasound (EUS)–guided sampling.
120
What is the primary advantage of surgical biopsy via mediastinoscopy over needle biopsy techniques like EBUS-TBNA?
Mediastinoscopy provides the entire lymph node for histologic examination, which is often better for diagnosis and subtyping, particularly for lymphoma.
121
The surgical procedure called _____ provides access to lymph nodes in the aortopulmonary window.
anterior mediastinotomy (Chamberlain procedure)
122
An enlarged thymus that appears in young patients following chemotherapy for lymphoma, mimicking recurrence, is known as _____.
thymic rebound
123
Mediastinal germ cell tumors (GCTs) that arise outside the reproductive organs are known as _____ GCTs.
extragonadal
124
What are the two main practical classifications of lymphomas?
Non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL).
125
Primary mediastinal B cell lymphoma (PMBCL), a rare subset of NHL, arises from B cell precursors in what organ?
The thymus.
126
A B cell lymphoma with histologic features of both PMBCL and classic nodular sclerosing HL is termed a _____.
mediastinal gray zone lymphoma
127
What is the defining feature of NUT carcinoma, a highly aggressive malignancy found in the mediastinum and other midline structures?
It is defined by a t(15;19) translocation, resulting in a BRD4-NUT fusion oncogene.
128
An aggregation of caseous lymph nodes into a mass-like lesion, often due to prior histoplasmosis or tuberculosis, is called a _____.
mediastinal granuloma
129
The prototypical, though dramatic, presentation of acute mediastinitis from spontaneous esophageal rupture is known as _____ syndrome.
Boerhaave syndrome
130
What is the most sensitive single imaging study for diagnosing mediastinitis of any origin?
A chest computed tomography (CT) scan.
131
In spontaneous esophageal rupture, the tear most commonly occurs along which wall of the distal esophagus?
The left posterolateral wall.
132
What two analogous procedures intentionally perforate the esophagus and large airways with fine needles to biopsy mediastinal lesions?
Transesophageal endoscopic ultrasound-guided fine-needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration.
133
Acute mediastinitis caused by direct extension of an oropharyngeal or cervical infection is known as _____.
descending necrotizing mediastinitis
134
What are the two most frequent bacterial isolates in post-sternotomy mediastinitis?
Staphylococcus epidermidis and Staphylococcus aureus.
135
Inhalational anthrax results in a characteristic hemorrhagic mediastinitis after spores are transported by macrophages to which location?
Hilar and mediastinal lymph nodes.
136
In cases of mediastinitis from esophageal perforation, antibiotic coverage should target oral and upper aerodigestive tract flora, which are often a polymicrobial mix of anaerobic and _____ bacteria.
aerobic
137
Fibrosing mediastinitis, mediastinal granuloma, and mediastinal adenitis are most commonly attributed to an aberrant immune response to which endemic fungus?
Histoplasma.
138
A key difference between fibrosing mediastinitis and mediastinal granuloma is that fibrosing mediastinitis is _____ while a granuloma causes extrinsic compression.
invasive
139
The most severe and often fatal late complication of Histoplasma infection, involving dense scar formation in the mediastinum, is _____.
post-Histoplasma fibrosing mediastinitis (PHFM)
140
How does thymic rebound appear on imaging and in what clinical context does it occur?
It appears as a benign enlargement of normal thymic tissue, which can occur after chemotherapy for lymphoma, potentially mimicking disease recurrence.
141
Which type of nonseminomatous germ cell tumor is also called an endodermal sinus or yolk sac tumor?
Embryonal cell carcinoma.
142
Which genetic syndrome has been associated with mediastinal germ cell tumors?
Klinefelter syndrome.
143
In what key way does the management of lymphoma differ from most other mediastinal lesions?
The management is primarily medical (chemotherapy/radiation), not surgical.
144
What are the classic 'B symptoms' that can accompany lymphoma?
Constitutional symptoms such as fever, weight loss, and fatigue.
145
Which two types of lymphoma, more common in female adolescents and young adults, arise from thymic B cell precursors and present as a bulky anterior mediastinal mass?
Primary mediastinal B cell lymphoma (PMBCL) and classic nodular sclerosing Hodgkin lymphoma (HL).
146
How is a mediastinal granuloma distinguished from fibrosing mediastinitis in terms of its interaction with adjacent structures?
A mediastinal granuloma can compress adjacent tissues but does not invade them, whereas fibrosing mediastinitis is invasive.
147
What is the most common tumor of the neurogenic group found in the posterior mediastinum?
Neurofibromas.
148
What is Mackler’s triad, and in what condition is it identified?
It is a triad of chest pain, vomiting, and subcutaneous emphysema, identified in a minority of patients with Boerhaave syndrome (esophageal rupture).
149
What is the pathophysiological cause of spontaneous esophageal rupture (Boerhaave syndrome)?
A sudden increase in intraesophageal pressure, typically during intense vomiting, causes the esophageal mucosa to dissect through muscle fibers and rupture.
150
Iatrogenic injury of the esophagus or trachea now accounts for the _____ of cases of mediastinitis caused by visceral perforation.
majority
151
Infections causing descending necrotizing mediastinitis are classically polymicrobial and include gas-producing organisms that effect rapid _____.
tissue necrosis
152
Which bacterial species is the cause of inhalational anthrax, also known as woolsorter's disease?
Bacillus anthracis.
153
Which commonly isolated anaerobic bacteria are found in mediastinitis from esophageal perforation?
Commonly isolated anaerobes include Bacteroides, Peptostreptococcus, Fusobacterium, Propionibacterium, and Prevotella species.
154
The mortality rate for esophageal rupture increases significantly if surgical intervention is delayed more than how many hours?
24 hours.
155
What is the key difference in pathogenesis between post-Histoplasma fibrosing mediastinitis (PHFM) and an active infection?
PHFM is caused by an aberrant and persistent immune response to Histoplasma remnants, not by an active, progressive infection.
156
Which imaging finding is considered pathognomonic for a late-stage mediastinal granuloma?
Speckled, subcapsular, or uniform calcification within the mass.
157
What is the most effective therapy for a symptomatic mediastinal granuloma (MG)?
Surgical drainage or resection is the most effective therapy.
158
Severe central chest pain that worsens with inspiration, accompanied by fever and enlarged, non-calcified mediastinal lymph nodes in a young adult, is a typical presentation for what condition?
Histoplasma-associated mediastinal adenitis.
159
What is the typical clinical course for symptoms of mediastinal adenitis caused by Histoplasma?
The symptoms typically remit spontaneously after a few weeks, though the nodal enlargement may persist.
Murray
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