# Mediastinal Lymphadenopathy Presenting With the "Medu Vada Sign"

## TL;DR

A new radiological sign called the 'Medu Vada sign' is described, which helps identify enlarged lymph nodes in the chest, especially in tuberculosis cases.

## Contribution

The paper introduces and formally names the 'Medu Vada sign' as a novel radiological marker for mediastinal lymphadenopathy.

## Key findings

- The 'Medu Vada sign' appears as a ring-like structure on CT scans due to enlarged mediastinal lymph nodes.
- The sign was observed in a patient diagnosed with tuberculous lymphadenitis.
- Recognizing this sign can aid in diagnosing mediastinal pathology in tuberculosis-endemic regions.

## Abstract

The "Medu Vada" (or "doughnut") sign is a compelling radiological finding often noted on axial chest CT scans, characterized by a circular or ring-like appearance. This distinct morphology arises from enlarged mediastinal adenopathy, specifically involving lymph nodes such as those in the subcarinal or right paratracheal areas, which encircle the adjacent airway or esophagus. We report the case of a 55-year-old female who presented with a constellation of non-specific constitutional symptoms, including chronic cough, significant weight loss, diminished appetite, and recurrent evening fevers. Diagnostic imaging revealed extensive mediastinal adenopathy that bore a striking resemblance to the classic "Medu Vada" configuration. Subsequent investigations confirmed a diagnosis of tuberculous lymphadenitis. This case highlights the importance of recognizing this specific imaging pattern, which we propose to formally name the "Medu Vada sign," as it can serve as a valuable clue in the differential diagnosis of mediastinal pathology, particularly in areas where tuberculosis is endemic.