Mediastinal masses-transthoracic ultrasonography aspects

Abstract

Mediastinal masses are usually assessed by computer tomography (CT) and magnetic resonance imaging (MRI). Transthoracic ultrasonography (TUS) can also provide useful information concerning prevascular and posterior mediastinal masses abutting the thoracic wall, but is underused for mediastinal pathology. Moreover, it provides a valuable and safe method for guiding interventional procedures in those areas, even in cases when other approaches are difficult or impossible. Considering TUS a very useful imagistic method for diagnosing mediastinal masses, we present a pictorial essay of various mediastinal diseases which can be assessed by this method.

Figure 1

A, Right parasternal hypoechoic, slight inhomogeneous lesion (mediastinal lipoma). B, Hypo vascularized lipoma in color Doppler mode.

Figure 2

A, Large hypoechoic ovoid-shape image with regular borders and inhomogeneous structure—retrosternal goiter sagittal scanned with convex transducer. B, Inhomogeneous upper retrosternal cystic lesion—hemorrhagic thyroid cyst.

Figure 3

A, Ovoid-shape slight inhomogeneous hypoechoic tumor surrounded by ventilated lung—right parasternal approach of timoma. B and C, Cystic lesion with floating echoes, thin walls, and small hypoechoic solid component—cystic timoma adjacent to the pulmonary trunk and left pulmonary artery.

Figure 4

Large irregular shape inhomogeneous prevascular mediastinal compartment tumor with necrotic areas—invasive thymoma.

Figure 5

A, Left parasternal echo free lesion with thin wall displacing laterally the ventilated lung—mediastinal cyst. B, Large left parasternal echo free lesion with thin septa and walls—mediastinal cyst.

Figure 6

A, Large hypoechoic irregular tumor engulfing brachiocephalic trunk and its branches (color Doppler mode)—right parasternal approach of a large B cell mediastinal lymphoma. B, Hypoechoic irregular shape inhomogeneous tumor, invading the anterior thoracic wall—B cell lymphoma.

Figure 7

A, Multiple hypoechoic enlarged lymph nodes, ovoid, or sphere-shaped, with malignant aspect at sagittal supra/retrosternal approach—metastatic embryonal rhabdomyosarcoma. B, Large hypoechoic mass surrounding left common carotid artery in patient with NSCLC with cervical lymph nodes metastasis. C, Large hypoechoic mediastino-pulmonary mass in a patient with left NSCLC invading the mediastinum.

Figure 8

A, Parasternal sagittal approach of an inhomogeneous tumor (hypoechoic peripherally and hyperechoic centrally) adjacent to descending thoracic aorta—SGCT. B, Large left prevascular mediastinal tumor with mixed structure—multiple hypoechoic necrotic intratumoral areas—Yolk sac tumor (NGCST).

Figure 9

Hypoechoic left paravertebral ovoid-shaped regular contoured tumor—schwannoma.

Figure 10

Paravertebral approach—hypoechoic irregular shaped lytic lesion of a vertebral transverse process (white arrow) —squamous carcinoma metastasis.