title: Sonographic management of mediastinal syndrome.
abstract: BACKGROUND
  Mediastinal syndrome is suspected on the basis of clinical symptoms and is generally confirmed by chest radiography or computed tomography (CT). However, also grey scale ultrasound (US) and contrast enhanced US (CEUS) are useful in this hematologic emergency as they provide the possibility to perform US-guided biopsy and histological diagnosis.
  
  
  METHODS
  15 Patients affected by mediastinal syndrome were prospectively studied using B-mode US and CEUS; 13 of these patients, who had no other lesions, were proposed for US-guided biopsy of the mediastinal mass, but only in 12 patients biopsy was technically possible.
  
  
  RESULTS
  In this study, B-mode US reached an excellent sensitivity (100%) in evidencing the lesions but a low specificity which did not exceed 30-40%. CEUS reached an elevated specificity identifying neoplastic pathologies if both the early and the late phases are considered (90-86.6%). US-guided biopsy was possible in 92.3% of lesions showing a diagnostic adequacy of 91.66%.
  
  
  CONCLUSIONS
  B-mode US associated with CEUS and US-guided biopsy reached an elevated accuracy in the diagnosis of mediastinal masses. If these results are confirmed by further studies, this diagnostic procedure could be included in the routine management of mediastinal syndrome.
authors: Division of Infectious Diseases, San Donato Hospital, ASL8, Arezzo, Italy.
authors: M
authors: M
authors: Caremani
authors: A
authors: A
authors: Benci
authors: D
authors: D
authors: Tacconi
authors: U
authors: U
authors: Occhini
authors: L
authors: L
authors: Lapini
authors: A
authors: A
authors: Caremani
keywords: Contrast enhanced US; Mediastinal syndrome; US-guided biopsy
references: AJR Am J Roentgenol. 1988 May;150(5):1021-6
references: 3282399
references: AJR Am J Roentgenol. 1994 Dec;163(6):1357-64
references: 7992728
references: Am J Respir Crit Care Med. 1996 Apr;153(4 Pt 1):1424-30
references: 8616576
references: AJR Am J Roentgenol. 2000 May;174(5):1279-84
references: 10789776
references: J Ultrasound Med. 2004 Jun;23(6):829-36
references: 15244307
references: N Engl J Med. 1992 Mar 5;326(10):678-87
references: 1736106
references: Radiology. 1990 Apr;175(1):137-43
references: 2179987
references: AJR Am J Roentgenol. 1997 Dec;169(6):1605-10
references: 9393174
references: Chest. 1997 Nov 5;112(5):1344-57
references: 9367479
references: Radiology. 1989 Aug;172(2):473-6
references: 2664870
references: Radiographics. 2000 May-Jun;20(3):653-71
references: 10835119
references: Radiol Med. 2006 Sep;111(6):759-72
references: 16896564
references: Thorax. 1992 May;47(5):377-80
references: 1609382
references: AJR Am J Roentgenol. 1998 Nov;171(5):1303-6
references: 9798868
references: AJR Am J Roentgenol. 1991 Feb;156(2):265-72
references: 1898797
references: Radiology. 2001 Apr;219(1):252-7
references: 11274566
references: Chest. 1997 Aug;112(2):511-22
references: 9266892
references: Chest. 1991 Aug;100(2):399-405
references: 1864114
references: AJR Am J Roentgenol. 2007 Apr;188(4):977-83
references: 17377033