Pneumomediastinography in the diagnosis of mediastinal masses

Pneumomediastinography in the Diagnosis of M ediastinal Masses By Jane Frank

and

I. Richard

Chicago,

Goldstein

III.

Pneumomediastinography is a relatively simple, safe, but little used diagnostic tool in pediatrics. Although it has been used in adults, relatively little has been written about this technique in pediatrics.‘-4 A clearly defined mediastinal mass requires an operation for definitive diagnosis and treatment, but there are instances in which it is difficult to differentiate between a normal thymus gland and a true tumor.

CASE REPORT Our patient

was an I I-yr-old

girl who was seen at another

hospital

for epigastric

pain

and

fever. Her only positive finding was a widened mediastinum found on a chest roentgenogram. The child was then referred to the Children’s Memoral Hospital, Chicago. She was asymptomatic and had no positive physical findings. A bone marrow aspiration and biopsy, skin tests, and a thyroid scan were all negative. A barium swallow demonstrated a mass to the left of the esophagus. Figure IA demonstrates a film obtained during linear tomography through the anterior mediastinal region. It demonstrates only a wide mediastinum with no calcifications. It did not help differentiate between a normal thymus gland or a tumor. She was referred for a possible diagnostic mediastinoscopy or thoractomy because radiographically an anterior mediastinal tumor could not be ruled out, However, rather than perform either of these surgical procedures a pneumomedistonogram was performed. The child was sedated and under sterile conditions the suprasternal notch was infiltrated with IY, lidocaine. A size 21 needle was curved at a 110” angle and inserted percutaneously through the suprasternal notch. The needle hugged the posterior surface of the manubrium. Fifty milliliters of carbon

Fig. 1.

dioxide

(A) Anterior

was then

slowly

and midmediartinol

(I 1976 b.v Grune & Stratton,

injected

region.

under

fluoroscopic

control.

The injection

was

(6) Normal thymus gland.

Inc.

Journal of Pediatric Surgery, Vol. 11, No. 2 (April), 1976

263

264

CASE REPORTS

stopped when the mediastinal structures were satisfactorily outlined. Immediately thereafter, linear tomography was again performed. Figure IB illustrates clearly the well outlined, typical configuration of a normal thymus gland. This patient illustrates the value of pneumomediastinography in delineating anterior thoracic structures. In this child the procedure made an operation for diagnosis unnecessary.

REFERENCES 1. lsrad HJ: Mediastinal Am J Roentgen01 Radium 15:711-118, 1956

pneumography. Ther Nucl Med

2. Hughes DL: Diagnostic pneumomediastinum. Radiology 78:12-18, 1962 3. Irvine WJ: Radiological assessment of the

thymus in thyroid 1:996-999, 1965

and

other

diseases.

Lancet

4. Sumerling MD: Pneumomediastinography. Am J Roentgen01 Radium Ther Nucl Med 98: 45 l-460, 196-l