Perforated gastric ulcer causing mediastinal emphysema: A case report

BACKGROUND Mediastinal emphysema is a condition in which air enters the mediastinum between the connective tissue spaces within the pleura for a variety of reasons.It can be spontaneous or secondary to chest trauma,esophageal perforation,medi-cally induced factors,etc.Its common symptoms are chest pain,tightness in the chest,and respiratory distress.Most mediastinal emphysema patients have mild symptoms,but severe mediastinal emphysema can cause respiratory and circulatory failure,resulting in serious consequences.CASE SUMMARY A 75-year-old man,living alone,presented with sudden onset of severe epigastric pain with chest tightness after drinking alcohol.Due to the remoteness of his residence and lack of neighbors,the patient was found by his nephew and brought to the hospital the next morning after the disease onset.Computed tomography(CT)showed free gas in the abdominal cavity,mediastinal emph-ysema,and subcutaneous pneumothorax.Upper gastrointestinal angiography showed that the esophageal mucosa was intact and the gastric antrum was perforated.Therefore,we chose to perform open gastric perforation repair on the patient under thoracic epidural anesthesia combined with intravenous anesthesia.An operative incision of the muscle layer of the patient's abdominal wall was made,and a large amount of subperitoneal gas was revealed.And a continued incision of the peritoneum revealed the presence of a perforation of approx-imately 0.5 cm in the gastric antrum,which we repaired after pathological examination.Postoperatively,the patient received high-flow oxygen and cough exercises.Chest CT was performed on the first and sixth postoperative days,and the mediastinal and subcutaneous gas was gradually reduced.CONCLUSION After gastric perforation,a large amount of free gas in the abdominal cavity can reach the mediastinum through the loose connective tissue at the esophageal hiatus of the diaphragm,and upper gastrointestinal angiography can clarify the site of perforation.In patients with mediastinal emphysema,open surgery avoids the elevation of the diaphragm caused by pneumoperitoneum compared to laparoscopic surgery and avoids increasing the mediastinal pressure.In addition,thoracic epidural anesthesia combined with intravenous anesthesia also avoids pressure on the mediastinum from mechanical ventilation.

Linear endoscopic ultrasound:Current uses and future perspectives in mediastinal examination

This editorial elaborates on the current and future applications of linear endoscopic ultrasound(EUS),a substantial diagnostic and therapeutic modality for various anatomical regions.The scope of endosonographic assessment is broad and,among other factors,allows for the evaluation of the mediastinal anatomy and related pathologies,such as mediastinal lymphadenopathy and the staging of central malignant lung lesions.Moreover,EUS assessment has proven more accurate in detecting small lesions missed by standard imaging examinations,such as computed tomography or magnetic resonance imaging.We focus on its current uses in the mediastinum,including lung and esophageal cancer staging,as well as evaluating mediastinal lymphadenopathy and submucosal lesions.The editorial also explores future perspectives of EUS in mediastinal examination,including ultrasound-guided therapies,artificial intelligence integration,advancements in mediastinal modalities,and improved diagnostic approaches for various mediastinal lesions.

Anterior mediastinal masses and thymic cysts

Cystic lesions of the anterior mediastinum in children suggest a well-known group of benign lesions that are comparatively frequent.Thymic cysts(TCs)are mostly positioned in the anterior mediastinum and some patients in the neck.Benign TCs classified as congenital intra-thoracic mesothelial cysts are commonly asymptomatic and have slight clinical significance.Multilocular TC,which can mimic another anterior mediastinal cystic tumor and is seen in adults,is more clinically important.It is a sporadic mediastinal lesion thought to arise in the course of acquired inflammation.Congenital mediastinal cysts represent 3%-6%of all mediastinal tumors and 10%-18%of radiologically reported mediastinal masses.Mediastinal TCs are uncommon and it is hard to know their true incidence.About 60%of cases with mediastinal TCs are asymptomatic,and the remainder of patients complains of nonspecific symptoms(e.g.,chest pain,dyspnea,or cough).The literature suggests that most cysts are benign,but an indefinite percentage may have a neoplastic process and result in significant compressive symptoms over time.Clinical symptoms of TCs vary depending on the location.In addition,frequent symptoms at the appearance of enlarged benign thymic and mediastinal cysts generally contain compressive symptoms(e.g.,respiratory distress,thymic pain,and symptoms related to Horner syndrome,hoarseness,dysphonia,dyspnea,orthopnea,wheezing,and fever).Many TCs have cystic density and a neat border and are simple to diagnose with radiological imaging.However,some TCs are hard to identify before surgery and may be misidentified as thymomas depending on their site and computed tomography results.Excision by thoracotomy,median sternotomy,or video-assisted techniques is essential for conclusive diagnosis,management,and abolition of relapse of anterior mediastinal masses and TCs.Histopathologic examination may be required after surgery.Considering the extent of the mass and the preliminary inability to make a definitive diagnosis,en bloc excision of the cyst was thought to be preferred to circumvent likely complications(e.g.,perforation,spillage of the contents,or incomplete excision).

Combining machine and deep transfer learning for mediastinal lymph node evaluation in patients with lung cancer

Background The prognosis and survival of patients with lung cancer are likely to deteriorate with metastasis.Using deep-learning in the detection of lymph node metastasis can facilitate the noninvasive calculation of the likelihood of such metastasis,thereby providing clinicians with crucial information to enhance diagnostic precision and ultimately improve patient survival and prognosis.Methods In total,623 eligible patients were recruited from two medical institutions.Seven deep learning models,namely Alex,GoogLeNet,Resnet18,Resnet101,Vgg16,Vgg19,and MobileNetv3(small),were utilized to extract deep image histological features.The dimensionality of the extracted features was then reduced using the Spearman correlation coefficient(r≥0.9)and Least Absolute Shrinkage and Selection Operator.Eleven machine learning methods,namely Support Vector Machine,K-nearest neighbor,Random Forest,Extra Trees,XGBoost,LightGBM,Naive Bayes,AdaBoost,Gradient Boosting Decision Tree,Linear Regression,and Multilayer Perceptron,were employed to construct classification prediction models for the filtered final features.The diagnostic performances of the models were assessed using various metrics,including accuracy,area under the receiver operating characteristic curve,sensitivity,specificity,positive predictive value,and negative predictive value.Calibration and decision-curve analyses were also performed.Results The present study demonstrated that using deep radiomic features extracted from Vgg16,in conjunction with a prediction model constructed via a linear regression algorithm,effectively distinguished the status of mediastinal lymph nodes in patients with lung cancer.The performance of the model was evaluated based on various metrics,including accuracy,area under the receiver operating characteristic curve,sensitivity,specificity,positive predictive value,and negative predictive value,which yielded values of 0.808,0.834,0.851,0.745,0.829,and 0.776,respectively.The validation set of the model was assessed using clinical decision curves,calibration curves,and confusion matrices,which collectively demonstrated the model's stability and accuracy.Conclusion In this study,information on the deep radiomics of Vgg16 was obtained from computed tomography images,and the linear regression method was able to accurately diagnose mediastinal lymph node metastases in patients with lung cancer.

Exploration and optimization of surgical techniques for laparoscopic transhiatal lower mediastinal lymph node dissection for adenocarcinoma of esophagogastric junction: A prospective IDEAL 2a study with qualitative design

Objective: To explore the change and feasibility of surgical techniques of laparoscopic transhiatal(TH)-lower mediastinal lymph node dissection(LMLND) for adenocarcinoma of the esophagogastric junction(AEG)according to Idea, Development, Exploration, Assessment, and Long-term follow-up(IDEAL) 2a standards.Methods: Patients diagnosed with AEG who underwent laparoscopic TH-LMLND were prospectively included from April 14, 2020, to March 26, 2021. Clinical and pathological information as well as surgical outcomes were quantitatively analyzed. Semistructured interviews with the surgeon after each operation were qualitatively analyzed.Results: Thirty-five patients were included. There were no cases of transition to open surgery, but three cases involved combination with transthoracic surgery. In qualitative analysis, 108 items under three main themes were detected: explosion, dissection, and reconstruction. Revised instruction was subsequently designed according to the change in surgical technique and the cognitive process behind it. Three patients had anastomotic leaks postoperatively, with one classified as Clavien-Dindo Ⅲa.Conclusions: The surgical technique of laparoscopic TH-LMLND is stable and feasible;further IDEAL 2b research is warranted.

Mediastinal lesions in children

The mediastinum is where thoracic lesions most frequently occur in young patients.The histological spectrum of diseases caused by the presence of several organs in the mediastinum is broad.Congenital lesions,infections,benign and malignant lesions,and vascular diseases are examples of lesions.Care should be taken to make the proper diagnosis at the time of diagnosis in order to initiate therapy promptly.Our task is currently made simpler by radiological imaging techniques.

Life-threatening delayed mediastinal and subcutaneous emphysema after general anesthesia in a rheumatoid arthritis patient: a case report

Background:Delayed mediastinal emphysema with subcutaneous emphysema after extubation is rarely reported in current literature.Symptomatic treatment is considered effective for management.Case presentation:We report a case of a 56-year-old female with longstanding rheumatoid arthritis under corticosteroid therapy who developed mediastinal emphysema with subcutaneous emphysema 2 days after recovering from general anesthesia for orthopedic surgery treating a femoral neck fracture.The patient received aggressive subcutaneous decompression and symptomatic management.Results:The patient’s condition improved after treatment.Based on computed tomography scan results,we hypothesize that the longstanding rheumatoid arthritis may have resulted in fragile lung tissue.Violent postoperative coughing likely caused rupture of small airways,leading to mediastinal emphysema.Conclusions:It is crucial to preoperatively assess the risk of airway injury in high-risk patients with longstanding rheumatoid arthritis.Delayed postoperative mediastinal emphysema should be carefully evaluated and managed aggressively to avoid exacerbation or life-threatening scenarios.Further research is warranted to elucidate the pathology and guide perioperative management in these patients.

Multilocular thymic cysts-a diagnostic challenge on computed tomography

A recent case report provided a patient scenario,wherein,a 39-year-old male patient presented with occasional palpitations,headache,and fever.Evaluation of tumor markers did not show any abnormal results.Subsequently,a computed tomography(CT)scan was undertaken,and its findings were affirmative of thymic cancer.Finally,the postoperative histopathological assessment of the mass,after its resection,confirmed it as an anterior mediastinal multilocular thymic cyst(MTC),with concurrent acute upper respiratory tract infection and acute myocarditis.Accordingly,this case report advocates the need for a preoperative histopathological examination with CT imaging to minimize the risk of confusing an MTC with a malignant thymic tumor.

Deep neck infections mortal complications:Intrathoracic complications and necrotising fasciitis

BACKGROUND We planned this study considering that complications of deep neck infections can be seriously life threatening.AIM To raise awareness that introthoracic complications and necrotizing fasciitis are causes of serious mortality and morbidity.METHODS This study was carried out with the participation of 188 patients who were treated at Mersin University Department of Otorhinolaryngology and Head and Neck Surgery at January 1,2024.When the patient files were retrospectively examined,16 of 188 patients(8.5%)were included in the study because they were observed to have necrotizing fasciitis and/or intrathoracic complications.RESULTS There were a total of 16 patients in this study,9 males(56.25%)and 7 females(43.75%).All patients were adults(>18 years)and the mean age was 50.37 years±15.37 years.Female patients had a mean age of 40.42 years±13.38 years,whereas for male patients was 58.11 years±12.44 years.CONCLUSION Patients with necrotizing fasciitis and/or intrathoracic complications require more complicated and serious surgeries,intensive care unit monitoring,and mechanical ventilator support.Higher rates of morbidity and mortality should be expected in Bal KK et al.Deep neck infections mortal complications WJCC https://www.wjgnet.com 6384 October 26,2024 Volume 12 Issue 30 these patients who are hospitalized for longer periods of time.

One Case of Right Posterior Mediastinum Intraneural Hemangioma Misdiagnosed as Neurilemmoma

Although rare, intraneural hemangiomas should be considered in the differential diagnosis of peripheral nerve lesions. We report on a 59-year-old female patient, who was admitted to the hospital due to the discovery of bilateral breast masses for 3 months, there was no paresthesia or dyskinesia. The patient accidentally found a mass in the right upper mediastinum while completing a plain chest X-ray, initially suspected as a benign neurilemmoma on CT. Surgical resection and pathological analysis confirmed an intraneural hemangioma. Unexpectedly, the patient developed new-onset right upper limb numbness and paresthesia 3 months post-operatively, probably related to surgical nerve injury. This case underscores the importance of maintaining a broad differential for mediastinal masses, and the potential for iatrogenic neurological complications when managing these rare, yet vascular lesions.

Thoracic Ganglioneuroma: A Rare Neural Tumor (Case Report and Literature Review)

Ganglioneuroma is an extremely rare tumor that is derived from neural crest. Many ganglioneuroma cases are detected incidentally unless they are large enough to cause compressive symptoms. We report an 18-year-old patient with posterior mediastinal ganglioneuroma which was abutting the descending aorta. The patient underwent successful resection by thoracoscopic approach and was followed up for one year with no complications. In summary, a detailed review with experts in both radiology and pathology is mandated to diagnose these tumors. Informed consent was obtained from the patient.

Endoscopic ultrasound:It’s accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review

AIM:To evaluate the accuracy of endoscopic ultrasound (EUS), EUS-fine needle aspiration (FNA) in evaluating mediastinal lymphadenopathy. METHODS:Only EUS and EUS-FNA studies confirmed by surgery or with appropriate follow-up were selected. Articles were searched in Medline, Pubmed, and Cochrane control trial registry. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Pooling was conducted by both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. RESULTS:Data was extracted from 76 studies (n = 9310) which met the inclusion criteria. Of these, 44 studies used EUS alone and 32 studies used EUS-FNA. FNA improved the sensitivity of EUS from 84.7% (95% CI:82.9-86.4) to 88.0% (95% CI:85.8-90.0). With FNA, the specificity of EUS improved from 84.6% (95% CI:83.2-85.9) to 96.4% (95% CI:95.3-97.4). The P forchi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION:EUS is highly sensitive and specific for the evaluation of mediastinal lymphadenopathy and FNA substantially improves this. EUS with FNA should be the diagnostic test of choice for evaluating mediastinal lymphadenopathy.

Tuberculous esophagomediastinal fistula with concomitant mediastinal bronchial artery aneurysm-acute upper gastrointestinal bleeding: A case report

BACKGROUND Esophagomediastinal fistula is a very rare complication of tuberculosis in otherwise healthy adults, and mediastinal bronchial artery aneurysm is even rarer. In this case report, we describe a rare case of tuberculosis complication that presented with acute upper gastrointestinal(GI) bleeding. It also highlights the benefits of chest computed tomography(CT) as an excellent adjunct diagnostic tool to endoscopy and bronchoscopy and the role of trans-arterial embolization as a minimal invasive therapy alternative to surgery.CASE SUMMARY A 19-year-old medically free male patient presented with acute multiple episodes of hematemesis for 1 d. Upper GI endoscopy, bronchoscopy, and chest CT with IV contrast confirmed esophagomediastinal fistula with mediastinal bronchial artery aneurysm. After resuscitating patient with IV fluid and blood product transfusion, trans catheter embolization was performed for mediastinal bronchial artery aneurysm.CONCLUSION We successfully treated a patient with acute upper GI bleeding due to tuberculous esophagomediastinal fistula and mediastinal bronchial artery aneurysm using transcatheter coil embolization.

Acute mediastinitis arising from pancreatic mediastinal fistula in recurrent pancreatitis

Acute mediastinitis is a fatal disease that usually originates from esophageal perforation and surgical infection.Rare cases of descending necrotizing mediastinitis can occur following oral cavity and pharynx infection or can be a complication of pancreatitis.The most common thoracic complications of pancreatic disease are reactive pleural effusion and pneumonia,while rare complications include thoracic conditions,such as pancreaticopleural fistula with massive pleural effusion or hemothorax and extension of pseudocyst into the mediastinum.There have been no reports of acute mediastinitis originating from pancreatitis in South Korea.In this report,we present the case of a 50-year-old female suffering from acute mediastinitis with pleural effusion arising from recurrent pancreatitis that improved after surgical intervention.

Clinical value of contrast-enhanced ultrasound in improving diagnostic accuracy rate of transthoracic biopsy of anteriormedial mediastinal lesions

Objective： To evaluate the clinical value of contrast-enhanced ultrasound（CEUS） in transthoracic biopsy of anterior-medial mediastinal lesions.Methods： A total of 123 patients with anterior or middle mediastinum lesions required ultrasound guided transthoracic biopsy for pathological diagnosis. Among them, 72 patients received CEUS examinations before biopsy. After CEUS, 8 patients were excluded from biopsy and the rest 64 patients underwent biopsy（CEUS group）. During the same period, 51 patients received biopsy without CEUS examination（US group）. The ultrasonography characteristics, the number of biopsy puncture attempts, diagnostic accuracy rate and the incidence of complications were recorded and compared between the two groups.Results： A large portion of necrosis area or superficial large vessels was found in 8 patients, so the biopsy was cancelled. The internal necrosis was demonstrated in 43.8% of the lesions in CEUS group and in 11.8% of US group（P0.001）. For thymic carcinoma, CEUS increased the detection rate of internal necrosis and pericardial effusion than conventional ultrasound（62.5% vs. 18.8%, P=0.012; 56.3% vs. 12.5%, P=0.023）. The average number of punctures in CEUS group and US group was 2.36±0.70 and 2.21±0.51 times, respectively（P0.05）. The diagnostic accuracy rate of biopsy in CEUS group（96.9%, 62/64） was significantly higher than that in US group（84.3%, 43/51）（P=0.022）. In US group, 2 patients suffered from mediastinal bleeding（3.9%）, while no major complications occurred in CEUS group.Conclusions： CEUS examination provided important information before transthoracic mediastinum biopsy and improved diagnostic accuracy rate in biopsy of anterior and middle mediastinum lesions than conventional ultrasound.

Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial

AIM To assess the efficacy of CO2 insufflation for reduction of mediastinal emphysema(ME) immediately after endoscopic submucosal dissection(ESD).METHODS A total of 46 patients who were to undergo esophageal ESD were randomly assigned to receive either CO2 insufflation(CO2 group, n = 24) or air insufflation(Air group, n = 22). Computed tomography(CT) was carried out immediately after ESD and the next morning. Pain and abdominal distention were chronologically recorded using a 100-mm visual analogue scale(VAS). The volume of residual gas in the digestive tract was measured using CT imaging. RESULTS The incidence of ME immediately after ESD in the CO2 group was significantly lower than that in the Air group(17% vs 55%, P = 0.012). The incidence of ME the next morning was 8.3% vs 32% respectively(P= 0.066). There were no differences in pain scores or distention scores at any post-procedure time points. The volume of residual gas in the digestive tract immediately after ESD was significantly smaller in the CO2 group than that in the Air group(808 m L vs 1173 m L, P = 0.013).CONCLUSION CO2 insufflation during esophageal ESD significantly reduced postprocedural ME. CO2 insufflation also reduced the volume of residual gas in the digestive tract immediately after ESD, but not the VAS scores of pain and distention.

Mediastinal node staging by positron emission tomographycomputed tomography and selective endoscopic ultrasound with fine needle aspiration for patients with upper gastrointestinal cancer:Results from a regional centre

AIM To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA) and positron emission tomography-computed tomography(PET-CT) in the nodal staging of upper gastrointestinal(GI) cancer in a tertiary referral centre.METHODS We performed a retrospective review of prospectively recorded data held on all patients with a diagnosis of upper GI cancer made between January 2009 and December 2015. Only those patients who had both a PET-CT and EUS with FNA sampling of a mediastinal node distant from the primary tumour were included. Using a positive EUS-FNA result as the gold standard for lymph node involvement, the sensitivity, specificity, positive and negative predictive values(PPV and NPV) and accuracy of PET-CT in the staging of mediastinal lymph nodes were calculated. The impact on therapeutic strategy of adding EUS-FNA to PET-CT was assessed.RESULTS One hundred and twenty one patients were included. Sixty nine patients had a diagnosis of oesophageal adenocarcinoma(Thirty one of whom were junctional), forty eight had oesophageal squamous cell carcinoma and four had gastric adenocarcinoma. The FNA results were inadequate in eleven cases and the PET-CT findings were indeterminate in two cases, therefore thirteen patients(10.7%) were excluded from further analysis. There was concordance between PET-CT and EUS-FNA findings in seventy one of the remaining one hundred and eight patients(65.7%). The sensitivity, specificity, PPV and NPV values of PET-CT were 92.5%, 50%, 52.1% and 91.9% respectively. There was discordance between PET-CT and EUS-FNA findings in thirty seven out of one hundred and eight patients(34.3%). MDT discussion led to a radical treatment pathway in twenty seven of these cases, after the final tumour stage was altered as a direct consequence of the EUS-FNA findings. Of these patients, fourteen(51.9%) experienced clinical remission of a median of nine months(range three to forty two months). CONCLUSION EUS-FNA leads to altered staging of upper GI cancer, resulting in more patients receiving radical treatment that would have been the case using PET-CT staging alone.

Incidence and treatment of mediastinal leakage after esophagectomy:Insights from the multicenter study on mediastinal leaks

BACKGROUND Mediastinal leakage(ML) is one of the most feared complications of esophagectomy. A standard strategy for its diagnosis and treatment has beendifficult to establish because of the great variability in their incidence and mortality rates reported in the existing series.AIM To assess the incidence, predictive factors, treatment, and associated mortality rate of mediastinal leakage using the standardized definition of mediastinal leaks recently proposed by the Esophagectomy Complications Consensus Group(ECCG).METHODS Seven Italian surgical centers(five high-volume, two low-volume) affiliated with the Italian Society for the Study of Esophageal Diseases designed and implemented a retrospective study including all esophagectomies(n = 501) with intrathoracic esophagogastric anastomosis performed from 2014 to 2017.Anastomotic MLs were defined according to the classification recently proposed by the ECCG.RESULTS Fifty-nine cases of ML were recorded, yielding an overall incidence of 11.8%(95%CI: 9.1%-14.9%). The surgical approach significantly influenced the occurrence of ML: the proportion of leakage was 10.5% and 9% after open and hybrid esophagectomy(HE), respectively, and doubled(20%) after totally minimally invasive esophagectomy(TMIE)(P = 0.016). No other predictive factors were found. The 30-and 90-d overall mortality rates were 1.4% and 3.2%,respectively; the 30-and 90-d leak-related mortality rates were 5.1% and 10.2%,respectively; the 90-d mortality rates for TMIE and HE were 5.9% and 1.8%,respectively. Endoscopy was the first-line treatment in 49% of ML cases, with the need for retreatment in 17.2% of cases. Surgery was needed in 44.1% of ML cases.Endoscopic treatment had the lowest mortality rate(6.9%). Removal of the gastric tube with stoma formation was necessary in 8(13.6%) cases.CONCLUSION The incidence of ML after esophagectomy was high mainly in the TMIE group.However, the general and specific(leak-related) mortality rates were low. Early treatment(surgical or endoscopic) of severe leaks is mandatory to limit related mortality.

DIAGNOSIS AND TREATMENT OF MEDIASTINAL ENTEROGENOUS CYSTS IN CHILDREN

Objective To investigate the diagnosis and therapy of mediastinal enterogenous cysts in children. Methods Clinical data of 17 cases with mediastinal enterogenous cysts within 19 years in our hospital were retrospectively analyzed. Results One case was intramural esophageal cyst and 16 cases were enteric cysts, two among which were complicated with abdominal enteric duplications. Most cases presented with symptoms of respiratory distress. Twelve cases were complicated with vertebral anomalies. Ultrasound helpful in confirming the cystic nature of these lesions. posterior mediastinum. of 12 cases and magnetic resonance imaging of 4 cases were Eight cases had technetium-99m pertechnetate scintigraphy of posterior mediastinum.Conclusions Most patients present with symptoms of respiratory distress, complicated with vertebral anomalies. Ultrasonography and magnetic resonance imaging may be helpful in confirming the cystic nature of these lesions. Technetium-99m pertechnetate scintigraphy is the most effective method for differentiation of the disease from other mediastinal cysts.

Efficacy of contrast-enhanced ultrasound-guided percutaneous core needle biopsy in anterior mediastinal masses

Objective:To evaluate the efficacy and safety of percutaneous core needle biopsy(PCNB)using ultrasound(US)-guided and contrast-enhanced ultrasound(CEUS)-guided procedures for anterior mediastinal masses(AMMs).Methods:In total,284 consecutive patients(166 men,118 women;mean age,43.0±18.4 years)who underwent PCNB for AMMs were enrolled.Patients were divided into the US-guided group(n=133)and the CEUS-guided group(n=151).PCNB was performed using a core needle(16-gauge or 18-gauge).Internal necrosis,diagnostic yield,and diagnostic accuracy were compared between the two groups.Results:The predominant final diagnosis of the cases in this study was thymoma(29.7%),lymphoma(20.5%),thymic carcinoma(13.3%),and germ cell tumour(13.3%),respectively.There was no significant difference in patient age,sex,number of percutaneous biopsies,or display rate of internal necrosis on conventional US between the two groups.The rate of internal necrosis of the lesions was significantly higher after contrast agent injection(72.2%vs.41.7%;P<0.001).The CEUS-guided group had a higher diagnostic yield than the US-guided group(100%vs.89.5%,P<0.001).There was no significant difference between the diagnostic accuracy of the CEUSguided and US-guided groups(97.3%vs.97.4%;P=1.000).None of the patients experienced adverse reactions or complications after US-guided or CEUS-guided PCNB.Conclusions:CEUS-guided PCNB can improve the diagnostic yield by optimizing the biopsy procedure.