Paratracheal Region Research Articles

Mediastinal tumors: sensitivity of detection with sonography compared with CT and radiography.

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.

Untersuchungstechnik und Indikation der mediastinalen Sonographie

The purpose of this report is to describe the technique of suprasternal and parasternal mediastinal sonography. Via the suprasternal approach, the supraaortic region, the paratracheal region and the aorticopulmonary window can be evaluated. The parasternal approach in right and left decubitus position is suitable for imaging the anterior mediastinum, pericardial and subcarinal spaces. The proportion of technically inadequate examinations of the different mediastinal compartments varies between 4 and 15%. The main indications for mediastinal sonography are described from our experience in the last 4 years.

Repair of subglottic stenosis with a free perichondrial graft

A case of tracheal stenosis was reconstructed, after trough formation, with a chondromucosal flap which was developed by submucous perichondrial grafting. At the first stage, a free perichondrial graft from the pinna was transplanted into the buccal submucosal layer. About 10 months later, when sufficient neocartilage had formed, the chondromucosal composite graft was transferred from the buccal region to the paratracheal subcutaneous region with the mucosa facing deeply. Finally, 4 weeks later the tracheal trough was closed with a composite rotation flap which incorporated the skin, neocartilage and mucosa. The postoperative course was uneventful and a wide tracheal lumen with a firm framework and mucous lining was confirmed by both fibrescopic and radiographic examination.

The neck after total laryngectomy: CT study.

Computed tomographic scans in 23 patients who had undergone total laryngectomy were analyzed retrospectively to determine normal postoperative appearance and to evaluate the role of CT in assessing recurrent neoplasm. Nine patients without clinical evidence of recurrence illustrated the normal postoperative changes: a round or ovoid neopharynx connecting the base of the tongue with the cervical esophagus and intact fat planes surrounding the neopharynx, neurovascular bundles, and sternocleidomastoid muscles. In the 12 patients with recurrent neoplasm, the CT manifestations included masses involving the internal jugular lymph node chain (adjacent to the neopharynx, neurovascular bundles, or sternocleidomastoid muscles), tracheostomy site, or paratracheal region. Recurrence was mimicked on CT in two patients, one with an abscess and one with metastases from an adenocarcinoma of unknown primary site. In eight patients, a distended neopharyngeal lumen correlated with benign or malignant stricture. CT supplemented physical examination and indirect mirror examination, providing data regarding presence and extent of recurrent tumor and aiding in planning the mode and scope of therapy.

Paratracheal abscess after tracheostomy

Mediastinal abscess formation in the paratracheal region is a complication of tracheostomy that has previously been only sparsely reported. We present a case which highlights this complication and illustrates some of the diagnostic difficulties with which it may be associated. In this case septicaemia-developed as a secondary complication and diagnosis of the abscess was dangerously delayed because the radiographic appearance masqueraded as a left upper lobe consolidation and because its rarity led to a low index of suspicion.

Computed tomography of the thorax in the diagnosis and management of malignant disease

The role of computed tomography (CT) scanning in the investigation of patients with intrathoracic malignancy has not yet been clearly defined. Current evidence suggests that it is the most sensitive diagnostic radiological imaging technique for identifying the extent of primary lung cancers and their relationship to intrathoracic anatomy. It is an advance in the staging of intrathoracic malignancy as it identifies adenopathy in the paratracheal region and the mediastinum more readily. Discovery of small (< 0.8 mm) pulmonary nodules is common in patients with some extrathoracic malignant conditions, but differentiating malignant deposits from benign nodules remains a problem. CT has a potential place in radiotherapy field planning and in identifying lung cancers in the occasional patient presenting with suspicious symptoms or positive cytology and a normal chest radiograph.

An evaluation of angiocardiography in pulmonary carcinoma with particular emphasis on prognosis.

The cure of cancer of the lung is primarily a surgical problem, virtually all long-term survivals having had surgically resectable disease. Unfortunately, resection can be undertaken in only about half of those patients (3) who come to thoracotomy; the remainder are incurable because of metastatic or unresectable lesions. During the last decade, a variety of diagnostic tests, including angiography, have been employed to help in the selection of those patients with lung cancer who present no other contraindications for surgery but are incurable by present surgical maneuvers. The use of angiocardiography in the study of pulmonary and mediastinal cancer has been attempted from both the point of view of diagnosis (7, 9) and of prognosis (4). The latter point has been investigated with particular respect to the prediction of resectability (1, 4, 10, 11, 14) of a lesion. It is the purpose of the present report to evaluate the efficacy of angiocardiography in the study of pulmonary cancer. Method The method used is venous angiocardiography, with the introduction of contrast medium into an arm or upper thoracic vein by way of a catheter inserted by a venous cut-down. The injection is made on the same side as the lesion and serves to evaluate the adjacent venous structures. It is performed either manually or with a mechanical injector. Rapid serial exposures record the passage of the medium through the pulmonary circulation, the left heart, and aorta. We have largely used the Elema biplane serialograph. Angiocardiographic Changes The vascular pattern of the lung and mediastinum is frequently altered by malignant intrathoracic disease. In 84 per cent of 250 consecutive proved cases of pulmonary and mediastinal cancer, Steinberg and Finby (12) found variations from normal. With lesions in close proximity to the hilar regions of the lung, this figure approaches 100 per cent, and in this location the problem of resectability is greatest. Angiocardiographic changes suggestive of cancer are mimicked by a sufficient number of nonmalignant conditions that the definitive diagnosis must be established by histologic study. Patterns of alteration will also differ with right and left hilar lesions. Angiocardiographic Criteria of Unresectability: The criteria of inoperability were first defined by Dotter, Steinberg, and Holman (4). We have found them to be of value in the following order: 1. Involvement of the great venous structures of the mediastinum (Fig. 1), the superior vena cava or the innominate veins. 2. Mediastinal mass lesions. Metastatic lymph-node involvement in the right paratracheal region (Fig. 2) means extensive mediastinal disease. 3. Major pulmonary artery involvement close to the hilus (Fig. 2). For the left pulmonary artery, the margin is 1.5 cm., and on the right is at the point of bifurcation of the right pulmonary artery. 4. Involvement of left atrium or of the major pulmonary veins (Fig. 3).