Follow-up of mediastinal lymphoma: role of ultrasonography.

PURPOSE: Patients with lymphoma are often young and require long and intensive treatment, the toxic effects of which compound the impact of frequent radiological examinations. Computed tomography (CT) is of great value in the evaluation of the mediastinum, which is frequently involved by the disease, but carries a high radiation load. Ultrasonography (US) has therefore been proposed as an alternative procedure to evaluate response to treatment. Major advantages include good compliance, absence of patient risks, low cost, easy reproducibility, dynamic images enabling multiplanar evaluation and qualitative and quantitative criteria. The purpose of this study was to investigate the role of US in evaluating response to treatment in patients with mediastinal lymphomas using CT as the gold standard. MATERIALS AND METHODS: In 2005, 12 patients were evaluated by chest X-ray, mediastinal sonography and contrast-enhanced CT (gold standard). Each mediastinal region was accurately assessed for adenopathies. Lymph nodes were studied by evaluating their structure and morphology, measuring their size and classifying them according to location. RESULTS: US proved to be more sensitive and accurate (93%) than X-ray [66% sensitivity and 68% diagnostic accuracy (DA)]. In particular, the best sensitivity values were observed in the supraaortic (97% vs. 55%), prevascular (97% vs. 39%) and paratracheal (87% vs. 77%) regions and in the aortopulmonary window (80% vs. 0%). Deeper mediastinal compartments (subcarinal region and posterior mediastinum) could not be assessed. X-ray proved to be superior in hilar adenopathies only. US provides qualitative information (hypoechoic or hyperechoic tissues) in addition to quantitative data (maximum diameter of each lymph node) it shares with CT. DISCUSSION.: Compared with X-ray, US allows for a better evaluation of the anterior mediastinal regions, showing small, central adenopathies that do not alter the mediastinal lines on X-ray. It is, however, of very limited value in the evaluation of posterior compartments because of their deep location. US adds qualitative criteria to the quantitative criteria typical of CT. Limitations of mediastinal US include site of adenopathies, dependence on the patient's characteristics (body habit, concurrent diseases and chest anatomy) and dependence on the operator. CONCLUSIONS: US may have a specific role in monitoring patients with mediastinal adenopathies, providing early indications on possible response to treatment and allowing the frequency of CT follow-up scans to be reduced. In conclusion, US may be used to complement, but not replace CT, which remains the gold standard.

Ultrasound diagnosis of pneumothorax.

PURPOSE: The purpose of this study was to show the effectiveness of ultrasound (US) in the evaluation of pneumothorax by comparison with X-rays and computed tomography (CT). MATERIALS AND METHODS: A series of 184 patients (130 men and 54 women), aged 26 to 82 years, underwent chest US after percutaneous needle biopsy. US findings were compared with CT postbiopsy selective slices and to X-rays. RESULTS: Pneumothorax was identified in 46 patients (25%) by CT, in 44 by US, with no false positives, and in 19 by X-rays. US sensitivity was 95.65%, specificity 100% and diagnostic effectiveness 98.91%. CONCLUSIONS: Chest US was found to be a valuable diagnostic tool in pneumothorax diagnosis, with diagnostic effectiveness well beyond X-rays and similar to CT.

The anterior mediastinum: anatomy and imaging procedures.

The mediastinum is divided into compartments (anterior, middle, posterior) on the basis of lateral chest radiographs. Several anatomical and radiological classifications of the mediastinum are reported in the literature. Most mediastinal abnormalities are initially suspected following chest radiography; the need for further investigation and the most appropriate imaging modality are largely dictated by the tentative diagnosis made on this examination. Although routine chest radiography initiates the evaluation of mediastinal disorders, it is rarely diagnostic: notable exceptions are teeth or bones within a mass, which are diagnostic of a teratoma; air/fluid levels suggest an oesophageal origin, hernia, cyst, or abscess. Chest radiography is followed by spiral computed tomography (sCT). However, even sCT with contrast material is occasionally diagnostic (a confident diagnosis can be made of some lesions such as mature teratoma and mediastinal goiter) but is usually sufficient for preoperative evaluation before mediastinotomy or mediastinoscopy: it is instrumental in planning further diagnostic workup. In certain cases, magnetic resonance imaging (MRI) may be complementary to sCT, but its use is not considered routine. Besides, although the anterior mediastinum is suitable for sonographic examination, the diagnostic value of ultrasonography has not been fully exploited. Thyroid scanning with radioactive iodine is useful in identifying and evaluating masses of suspected thyroid origin. The role of fluorodeoxyglucose positron emission tomography (FDG-PET) in mediastinal diseases continues to be evaluated: it has potential for differentiating between benign and malignant disease and is expected to play a more extensive role in the imaging of mediastinal neoplasms in the future. In this paper, the radiological features of masses located in the anterior mediastinum are discussed, with particular reference to radiographic and CT patterns useful to the clinician's everyday practice.

[Giant mucocele of appendix. Case report]. / Mucocele appendicolare gigante. Caso clinico.

Appendiceal mucocele is an uncommon disorder caused by accumulation of mucus within the appendiceal lumen. Mucoceles represent a heterogeneous group comprising various histopathologic lesions including mucosal hyperplasia, cystoadenomas, and cystoadenocarcinomas and prognosis is related to these subtypes. The most common symptom is pain or a palpable mass in the right lower quadrant on physical examination. The preoperative diagnosis is performed with abdominal U.S. and confirmed with CT scan; typical CT scan image is a capsulated cystic mass with calcification of the wall while U.S. pattern shows cystic lesion with the onion skin sign considered a specific sonographic marker for appendiceal mucocele. In conclusion a cystic mass sonographically detected with onion skin sign, in the presence of normal female reproductive organs, suggest the diagnosis of appendiceal mucocele.

Three-year findings of an early lung cancer detection feasibility study with low-dose spiral computed tomography in heavy smokers.

BACKGROUND: Low-dose spiral computed tomography (sCT) showed a four-fold increase in the detection rate in high-risk subjects and a higher percentage of stage I lung cancer in comparison with chest X-ray. However, there is a considerable discrepancy among studies in the percentage of lung nodules, overall lung cancer and stage I detection rate. SUBJECTS AND METHODS: From April to December 2001, 520 asymptomatic volunteers aged >or=55 years with a history of cigarette smoking >or=20 pack-years and no previous cancer were enrolled to receive an annual sCT of the chest for five consecutive years. RESULTS: Seventy three per cent were male, median age was 59 years and 91% were current smokers. At baseline, nodules >or=5 mm were detected in 114 (22%) undergoing sCT; the size of lung nodules ranged from 5 to 9.9 mm in 81.5% of the cases. Five (1%) cases of lung cancer were detected. In two additional cases a pathological diagnosis of atypical adenomatous hyperplasia was made. Three new cases of lung cancer were detected in the second and third year of the study. One interval case was detected during the third year. CONCLUSIONS: Despite some promising data, convincing evidence from ongoing randomized trials is needed to support the routine use of sCT as a recommended tool for screening of lung cancer.