Thoracic Ultrasound and Integrated Imaging by Francesco Feletti & Bruna Malta & Andrea Aliverti

Author:Francesco Feletti & Bruna Malta & Andrea Aliverti
Language: eng
Format: epub
ISBN: 9783319930558
Publisher: Springer International Publishing

8.3.3 Clinical Work-Up of Mediastinal Lymphadenopathy Using Ultrasound Techniques

Enlargement of mediastinal lymph nodes is a frequent finding in inflammatory and neoplastic diseases. Conventional chest radiography and thoracic CT are first-line diagnostic methods to evaluate suspected mediastinal lymphadenopathy [3, 59]. In addition, ultrasound modalities offer guidance for biopsy and intervention, and deliver higher spatial resolution. Ultrasound methods allow not only size-related criteria as shown for CT and magnetic resonance imaging (MRI) but also evaluation of the lymph node architecture [82, 83], lymph node vascularity and perfusion [84–87], resistance index [88], lymph node elasticity [89–92], and changes of perfusion during anti-angiogenetic treatment [1, 84]. This multiparametric sonographic evaluation may be helpful to differentiate very hypoechoic lymph nodes from cystic masses (Fig. 8.3) and to direct EUS-FNA or EBUS-TBNA (Figs. 8.4 and 8.5).

Fig. 8.3A well-circumscribed para-aortic lesion (station 6) was identified on CT in a 72-year-old male patient and suspected to be an enlarged lymph node (a). With EUS the lesion appears to be anechoic (b). After optimizing scope position, the lesion reveals a slightly inhomogeneous hypoechoic echopattern. EUS-FNA would be technically feasible (c). However, contrast-enhanced EUS reveals complete lack of vascularization (d). Therefore, the lesion was diagnosed a bronchogenic cyst, and due to the high risk of mediastinitis, EUS-FNA was avoided (asterisk, Ln? lesion suspected to be a lymph node, Ao aorta, Pa pulmonal artery, yellow oval position of the longitudinal echoendoscope within the esophageal lumen)

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