Mediastinal tumors: sensitivity of detection with sonography compared with CT and radiography

Article Abstract:

The mediastinum is the middle portion of the chest cavity that contains the heart, esophagus, thymus, and other organs and lymph nodes, except for the lungs. Tumors affecting these organs and tissues are usually diagnosed from chest X-rays. Computed tomography (CT) and magnetic resonance (MR) imaging have also been used to detect these tumors. Sonography, a diagnostic imaging technique that uses ultrasound or high-frequency sound waves, has been suggested as another possible means of detecting these tumors. This study compared sonography with CT and chest X-rays in their ability to detect mediastinal tumors. All three techniques were performed on 182 patients suspected of having a mediastinal tumor. CT results were the standard against which sonography and chest X-rays were evaluated. Results showed that 195 mediastinal tumors were detected using CT. Sonography was able to detect 176 (90 percent) of these tumors. Evaluation of sonographic images of the 19 tumors that were missed showed that two were hidden by overlying artifacts, and contrast was not adequate in the others. Chest X-rays were only able to detect 57 percent of the mediastinal tumors that were found using CT. The sensitivity of sonography in detecting tumors varied somewhat according to the chest compartment, with a greater than 89 percent sensitivity found in the supraaortic, pericardial, prevascular, and paratracheal compartments. These results show that sonography is much better at detecting mediastinal tumors than are chest X-rays, and that it is sensitive enough in some chest compartments that CT and MR may not be needed to confirm results. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Radiography, Thoracic tumors

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Mediastinal tumors: biopsy under US guidance

Article Abstract:

Mediastinal percutaneous biopsy of tumors using ultrasound (US) to guide the needle between the two portions of an organ during the biopsy procedure, is a new technique that is being evaluated. At present mediastinal percutaneous biopsy of tumors is achieved through the use of computed tomography (CT). Use of US guided biopsy was considered feasible and performed in 14 of 24 patients referred for mediastinal tumor biopsy. The essential criterion for patient selection was the availability of an avascular approach to the mediastinal tumor. An avascular approach is one characterized by few blood vessels or limited blood perfusion. In the remaining seven patients, percutaneous biopsy was performed under CT guidance, due to the inability to identify suitable routes of approach to the lesions with US. The researchers found that US has all the advantages of spatial orientation offered by CT and also provides continuous monitoring of the biopsy of mediastinal tumors under real-time conditions. The basic limited factors of sonographic guidance are the narrow parasternal and suprasternal acoustic windows. Sonographic guidance was mainly suitable for the biopsy of anterior mediastinal tumors. In conclusion, the US guided biopsy of mediastinal tumors proved to be a technically simple, fast, and accurate procedure that could largely replace the less precise tandem technique performed under CT guidance. Its application is, however, limited by tumor location.

Care and treatment, Methods, Evaluation, Tumors, Tomography, Biopsy, Needle, Needle biopsy, Mediastinum

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Thymic involvement in Hodgkin disease: CT and sonographic findings

Article Abstract:

Hodgkin disease is a malignant abnormality of unknown cause characterized by enlargement of the lymph nodes, spleen, and often the liver and by transformed lymphocytes. Recent studies have indicated the thymus may also be involved in Hodgkin disease, but methodological problems with those studies leave the issue unresolved. To evaluate the possible involvement of the thymus in Hodgkin disease, 43 patients with newly diagnosed cases of the disease underwent thymic examination with computed tomography (CT) and ultrasonography (US). The patients were evaluated both before and after undergoing therapy. CT performed prior to therapy showed clear evidence of thymic enlargement in 17 patients and no evidence in 15 patients. Findings were equivocal for 11 patients, but follow-up scans showed enlargement of the thymus had been present in seven of the 11 cases. In the 24 patients with an enlarged thymus, the internal texture of the thymus was initially homogenous in six, inhomogeneous and nodular in 13, and contained cysts in five. Following therapy, the thymus remained enlarged in nine patients. US was able to detect the enlarged thymus glands, but not the normal glands. The results indicated that thymic enlargement in Hodgkin disease is more prevalent than previously reported. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Hodgkin's disease, Complications and side effects, Thymus, Thymus gland

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