Intrathoracic Tumors, Their Diagnosis and Treatment

Abstract

NO new principles have been evolved in the diagnosis and treatment of intrathoracic tumors, but the writers desire to report several cases which have been under observation, possessing as they do some special features which may be of interest to radiologists. In the roentgenologic examination of the chest for a possible newgrowth the following plan was followed: (1) The demonstration of an abnormal shadow in the thoracic cavity. Within the visible part of the lung-field in the usual anteroposterior view, any abnormal shadow is readily recognized, but if located in the mediastinum, it may be entirely obscured by the heart and great vessels. To establish its presence with certainty the usual anteroposterior view must be supplemented by a lateral one. (2) The localization of the abnormal shadow. For exact localization of this shadow, we have found that the true anteroposterior and lateral views are the most useful positions. Stereoscopic examination of the chest in the anteroposterior-position gives little information as to location, and none if the shadow is obscured by the heart and great vessels. (3) The origin of the abnormal shadow. Its location having been settled, its origin must be determined if possible. This is generally accomplished by the study of the abnormal shadow in relation to the surrounding structures from every possible angle. If this method is unsuccessful, other means are resorted to, such as the induction of artificial pneumothorax, or the introduction of an opaque medium into the tracheo-bronchial tree, or the evacuation of pleuritic fluid, which, when present, is apt to obscure entirely the abnormal shadow. Mention should be made of the bronchoscope which has proved to be of great value in not only determining the origin of the abnormal shadow, but enabling one to obtain a specimen for microscopic examination and the application of local treatment, if such is indicated. (4) Is the abnormal shadow inflammatory or neoplastic in origin? As a rule, little difficulty is met with in differentiating between an inflammatory and a neoplastic process. However, in the region of the mediastinum in which aneurysms are of frequent occurrence, the differentiation between the two processes is often quite difficult. Pulsations of the expansile type usually indicate an aneurysm; however, absence does not exclude it. The chest must be studied from every possible angle in order to determine the exact relation between the abnormal shadow, the heart, and great blood vessels. If the shadow is an aneurysm it cannot be separated from the aorta, but if neoplastic it may be dissociated from the latter. The ofttimes observed extensive destructive changes in the ribs, sternum, and spine indicate the aneurysmal character of the mass, for neoplasms seldom cause much bony change. Finally, one must take full cognizance of the clinical history, which may shed considerable light upon the nature of the tumor.