Queensland Government
Queensland Government
Home / Refer your patient / Respiratory and Thoracic Medicine / Mediastinal lymphadenopathy

Mediastinal lymphadenopathy

Emergency department referrals

All urgent cases must be discussed with the on-call Registrar to obtain appropriate prioritisation and treatment. Contact through

  • Caboolture Hospital (07) 5433 8888
  • Redcliffe Hospital (07) 3883 7777
  • Royal Brisbane and Women’s Hospital (07) 3646 8111
  • The Prince Charles Hospital (07) 3139 4000

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • Evidence of SVC obstruction
  • Significant hypercalcaemia
  • Radiological evidence of airway obstruction

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Pathological mediastinal lymphadenopathy (nodes ≥ 15–20 mm)
  • Mediastinal lymphadenopathy with significant extra thoracic nodes on imaging. Consider concurrent referral to haematology where clinical or radiological features suggest haematological malignancy including lymphoma.
  • Associated hypercalcaemia, new kidney impairment, weight loss or unexplained sweating
  • Radiological features suggestive of active pulmonary process including tuberculosis

Category 2

Appointment within 90 days is desirable

  • Mediastinal lymphadenopathy with nodes 10-15 mm with no other concerning features which persist on follow up imaging after at least 3 months

Category 3

Appointment within 365 days is desirable

  • Mediastinal lymphadenopathy requiring follow up but stable on serial imaging for >6-12 months

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • Refer to HealthPathways or local guidelines.
  • Mediastinal nodes are considered enlarged if > 10 mm. Mediastinal lymphadenopathy is most commonly reactive but may represent significant conditions such as lung cancer, lymphoma, sarcoidosis or, in the right scenario, tuberculosis.
  • The risk of serious pathology is associated with age, size of nodes (especially > 20 mm) and personal history of malignancy.
  • Calcified mediastinal lymph nodes may be seen with history of tuberculosis, silicosis or sarcoidosis.
  • Mild lymphadenopathy (10 -15 mm) is usually followed by repeat CT scan after 3-6 months.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • CT chest and details of radiology provider
  • Biochemistry results (calcium and renal function)
  • Details and pathology results (if available) of previous malignancies

Additional referral information

  • Occupational history

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
Back to top