Ultrasound of the chest and mediastinum in children, interventions and artefacts. WFUMB review paper (part 3)
Cheng FangJoanna JaworskaNatalia BudaIoana Mihaiela CiucăYi DongAxel FeldkampJörg JüngertWojciech KosiakHans Joachim MentzelCorina PienarJorge S. RabatVasileios RafailidisSimone SchradingDagmar Schreiber-DietrichChristoph F. Dietrich
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Abstract:
Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, realtime imaging, and lack of ionizing radiation and bedside availability. The lack of superficial adipose tissue and favourable acoustic windows in children makes US the first line of investigation for evaluation of pleural and chest wall abnormalities.In the first part of the topic the technical requirements were explained and the use of ultrasound in the lung and pleura in paediatric patients were discussed. In the second part lung parenchymal diseases with their subpleural consolidations are reflected. In the third part, the use of ultrasound for chest wall, mediastinum, diaphragmatic diseases, trachea, interventions and artifacts in paediatric patients are summarized.40 patients with suspected mediastinal tumors were independently examined with computed tomography (CT) and sonography. The findings were confirmed by bronchoscopy, mediastinoscopy or surgery. In the assessment of the upper and middle mediastinum, sonography reaches a high sensitivity. On the contrary, in the evaluation of the anterior and posterior mediastinum, sonography is clearly inferior to CT. 90% of the tumors demonstrated by CT could be assessed with sonography. The most frequent tumors can be diagnosed with ultrasound. The evaluation of tumors in the paravertebral and retrosternal space is limited. Sonography of the mediastinum is a noninvasive, well-reproducible and cost-effective imaging modality that provides important information in cases of unclear X-ray and CT findings. The preliminary results encourage to a more frequent use of mediastinal sonography.
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SHAPE CHARACTERIZATION OF MEDIASTINUM IN TUBERCULOSIS CHEST RADIOGRAPHS USING LEVEL SET SEGMENTATION
Mediastinum is considered as one of the substantial anatomical regions for the gross diagnosis of several chest related pathologies. The geometric variations of the mediastinum in Chest Radiographs (CXRs) could be utilised as potential image markers in the early detection of Tuberculosis (TB). This study attempts to segment mediastinum in CXRs using level sets for the shape characterization of TB conditions. The CXR images for this study are considered from a public database. An edge-based distance regularized level set evolution is employed to segment the lungs followed by a region-based Chan-Vese model that extracts mediastinum region. Features such as mediastinum area and lungs area are extracted from the segmented images. Further, mediastinum to lungs area ratio is calculated. Statistical analysis is performed on the features to differentiate normal and TB images. Results show that the proposed segmentation approach is able to segment the lungs and extract the mediastinum in CXRs. It is found that features namely mediastinum area and mediastinum to lungs area ratio are statistically significant in the differentiation of TB. Larger mediastinum area is observed in TB images as compared to normal. The performance of lung field segmentation is also observed to be in line with the literature. The mediastinum segmentation approach in CXRs obtains to be a novel method as compared to the existing methods. As the proposed approach based on mediastinum image analysis provides better shape characterization, the study could be clinically useful in the differentiation of TB conditions.
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Lesions in mediastinum can represent malignancy and warrants further workup. Commonly a diagnosis is achieved by conventional bronchoscopy, transbronchial needle aspiration or CT guided fine needle aspiration, however a number of patients remain undiagnosed despite these common investigationsDuring a period of 36 months 601 patients underwent EBUS at our institution. Two hundred ninety three patients had an established diagnosis of lung cancer and were referred to us for mediastinal staging. The remaining patients had a radiologically suspicious intrathoracic lesion of which 107 had an undiagnosed lesion in mediastinum. All patients had been investigated by previous chest CT and bronchoscopy including brush cytology but remained undiagnosed.Of the 107 patients with undiagnosed lesions in the mediastinum 89 enlarged lymph nodes and 18 mediastinal tumours. Forty-eight of the 89 patients (54%) with enlarged mediastinal lymph nodes were diagnosed by EBUS of the remaining 41 patients 11 went on to more invasive methods. In patients with undiagnosed tumours in mediastinum we achieved a final diagnosis by EBUS in 14 of the 18 patients (78%) and 3 went on to more invasive methods.EBUS provides a final diagnosis in 78% of patients with tumour in mediastinum and in more than half of patients with enlarged lymph nodes despite previous workup.
Endobronchial ultrasound
Mediastinal lymphadenopathy
Mediastinal Diseases
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Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation. But there is also an entire spectrum of atypical and uncommon ultrasound features and our review comes to detail these particular aspects. An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance [ultrasound/ computed tomography/or magnetic resonance imaging (MRI)]. For a clinician who practices ultrasound and has an ultrasound system in the room, the easiest, fastest, non-invasive and cost-effective method is contrast enhanced ultrasound (CEUS). Approximately 85% of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography (CT)/MRI appointment. In less than 15% of patients CEUS does not provide a conclusive appearance; thus, CT scan or MRI becomes mandatory and liver biopsy is rarely required. The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast, non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma.
Contrast-enhanced ultrasound
Liver Hemangioma
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Abstract. The purpose of the study. Dissemination of ideas about the peculiarities of the course of post-traumatic purulent mediastinitis, against the background of penetrating gunshot wounds of the chest for further improvement of diagnosis and treatment of this formidable complication.
Material and methods. The study is based on the analysis of 30 observations of post-traumatic purulent mediastinitis, and 13 (32 %) of the injured were characterized by the predominance of phlegmon of the mediastinum, and in 17 (68 %) — observations of limited suppuration of the mediastinum dominated.
Results and discussion. The average age at mediastinal phlegmon was 20 % higher compared to observations of limited mediastinal suppuration (37.2 and 44.6 years, respectively). The vast majority of the wounded were in the most working age (21–50 years): 82.8 % and 63.6 %, respectively. Abscesses were more often localized in the anterior mediastinum (33.3 %), while in case of phlegmon, tissue of the posterior mediastinum was more often involved or a total lesion of the mediastinum was observed (64.7 %). The maximum lethality (35.1 %) was observed with phlegmon of the posterior mediastinum or with a total lesion of the mediastinum, and the minimum – with abscesses of the anterior mediastinum (5.5 %).
Conclusions. Thus, the work considered 30 cases of post-traumatic purulent mediastinitis, and 13 (32 %) of the wounded were characterized by the predominance of phlegmon of the mediastinum, and in 17 (68 %) — limited suppuration of the mediastinum dominated. All of the above indicates the need for further in-depth study of this complex and still not fully resolved problem.
Phlegmon
Mediastinitis
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Multidetector Computed Tomography Evaluation of Mediastinal Lesions with Histopathological Diagnosis
The evaluation of mediastinal abnormalities is a challenging radiographical problem. Cross-sectional imaging of the mediastinum by computed tomography now demonstrates precise anatomic details and is the imaging modality of choice for most mediastinal lesions. The following study was undertaken with the objectives of determining the mediastinal lesions affecting the mediastinum and to correlate the computed tomography findings with the histopathology reports. In this study, 50 patients clinically suspected with mediastinal mass lesions or who had chest radio-graph with a suspicious mediastinal lesion were evaluated from October 2013 to September 2014. In our study, we used varying computed tomography features of each mediastinal pathology types to predict a histological diagnosis of mediastinal lesions. Most of the lesions could be predicted with good sensitivity, specificity and diagnostic accuracy.
Histopathology
Multidetector computed tomography
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Objective To analyze the application value of ultrasound, MRI and CT in the diagnosis of primary gallbladder carcinoma. Methods The imaging data of 50 patients with primary gallbladder carcinoma confirmed by operation and pathology were retrospectively analyzed. All patients underwent ultrasound examination. 40 cases underwent CT examination and 25 cases underwent MRI examination. The imaging findings were observed and analyzed, respectively. Meanwhile, the findings were compared with the results of operation and pathological examination. The accuracy of the three kinds of examinations in the diagnosis of primary gallbladder carcinoma was compared. ResultsCompared with operation and pathological results, the diagnostic accordant rates(accuracy) of ultrasound, CT and MRI were 64.0%, 73.3% and 88.0%. The diagnostic accuracy of MRI was significantly higher than that of ultrasound, and the difference was statistically significant(P0.05). Conclusion Ultrasound, MRI and CT in the diagnosis of primary gallbladder carcinoma have their own advantages and disadvantages, and the diagnostic accordant rates of MRI was the highest while of ultrasound was the lowest.
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Neuroradiology
Interventional radiology
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