Abstract
Mediastinal masses span a wide histopathological and radiological spectrum. Anterior mediastinal tumors account for 50% of all mediastinal masses, including thymoma, teratoma, thyroid disease, and lymphoma. Ultrasound guidance can be used for biopsy of anterior mediastinal lesions that extend to the anterior parasternal chest wall with the advantage of being a real-time procedure and its ability to perform the biopsy at the bedside of critically ill or dyspneic patients. The aim of this study was to evaluate the efficacy and safety of using ultrasonography as a guiding modality during percutaneous biopsies for anterior mediastinal lesions. This prospective study for diagnostic accuracy was conducted on 22 patients with anterior mediastinal masses. In total, lesions in 19 patients were approached through parasternal approach under local anesthesia using lidocaine 2% and in two patients the lesions were approached through suprasternal approach. Lesion in one patient failed to be approached by either parasternal or suprasternal approach because of its deep location. Conclusive results were obtained in 18 patients (81.8%), nonconclusive results in three patients (13.6%), and biopsy was not performed for one patient (4.6%) because of technical difficulty. Malignant lymphoma was the most encountered pathological diagnosis. Two patients developed vasovagal attacks at the beginning of the procedure. No procedure-related mortality was encountered in this study. Ultrasound-guided biopsy is a useful technique for anterior mediastinal lesions with a good diagnostic yield (81.8%) and minimal complications.
Highlights
Mediastinal masses span a wide histopathological and radiological spectrum
Conclusive results were obtained in 18 patients (81.8%), nonconclusive results in three patients (13.6%), and biopsy was not performed for one patient (4.6%) because of technical difficulty
The most frequent lesions encountered in the mediastinum are thymoma, neurogenic tumors, and benign cysts, altogether representing 60% of patients with mediastinal masses
Summary
The most frequent lesions encountered in the mediastinum are thymoma, neurogenic tumors, and benign cysts, altogether representing 60% of patients with mediastinal masses. Neurogenic tumors, germ cell neoplasms, and foregut cysts represent 80% of childhood lesions, whereas primary thymic neoplasms, thyroid masses, and lymphomas are the most common lesions in adults [1]. Many mediastinal reflections can be appreciated at conventional radiography, and their presence or distortion is the key to the interpretation of mediastinal abnormalities [3]. MRI is largely used as an adjunct to CT scanning in the evaluation of mediastinal abnormalities; it often provides additional information about the nature, location, and extent of the disease [6]. Anterior mediastinal tumors account for 50% of all mediastinal masses, including thymoma, teratoma, thyroid disease, and lymphoma. Ultrasound guidance can be used for biopsy of anterior mediastinal lesions that extend to the anterior parasternal chest wall with the advantage of being a real-time procedure and its ability to perform the biopsy at the bedside of critically ill or dyspneic patients
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