The purpose of this prospective study was to evaluate the sensitivity of mediastinal sonography compared with computed tomography (CT) and chest radiography in the detection of mediastinal tumors. The sonograms, CT scans, and chest radiographs of 182 patients were interpreted blindly by three observers, and the results were compared. The proportion of diagnostic sonographic examinations varied for the different mediastinal compartments from 85% (subcarinal region) to 96% (supraaortic region). The sensitivities of sonography and chest radiography, respectively, for each compartment, with CT as the reference method, were as follows: supraaortic region, 98% and 67%; paratracheal region, 89% and 69%; aorticopulmonary window, 81% and 62%; prevascular region, 92% and 46%; subcarinal region, 69% and 31%; pericardial region, 100% and 67%; posterior mediastinum, 6% and 6%; and paravertebral region, 11% and 44%. These results show that sonography is superior to chest radiography in the diagnosis of mediastinal tumors. In certain mediastinal regions (supraaortic, pericardial, prevascular, and paratracheal), sonography is so sensitive that CT and magnetic resonance examinations may be obviated in patients with equivocal radiographic findings.
Subjects and Methods
Selection of PatientsAll patients referred for a CT examination of the mediastinum within a 2-month period were The patients (1 1 women, 1 6 men) were 20-58 years old (average age, 35). In patients with Hodgkin (n = 8) and non-Hodgkin (n = 8) lymphoma, only histologic proof from peripheral lymph nodes was available. In four patients, biopsies were consistent with sarcoidosis; two were confirmed by mediastinoscopy and two by bronchoscopy. Diagnoses were surgically proved in two patients with thymomas, one patient with bronchogenic carcinoma, one patient with a malignant fibrous histiocytoma, and one patient with an unclassified sarcoma. One patient each had mediastinal metastases of melanoma and testicular carcinoma.
Twelve patients with mediastinal masses evaluated by computed tomography (CT) and histologically verified were evaluated sonographically by means of the suprasternal approach. Eleven of 12 mediastinal tumors could be visualized sonographically, mainly as hypoechoic and perivascularly situated masses, and could be located topographically with a fair degree of certainty. Suprasternal sonography is particularly useful in the detection of small, perivascular lymphomas of the supraaortic branches. In patients with problematic CT findings, particularly children and patients with allergies to contrast media, suprasternal sonography can provide important additional information. Moreover, suprasternal sonography can be used to determine the consistency and to monitor the treatment of mediastinal tumors. Finally, the suprasternal approach is suitable for sonographically guided biopsies of mediastinal tumors.
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