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US-guided transthoracic puncture of small peripheral lung nodules and left anterior mediastinal masses
EUROPEAN JOURNAL
OF
~ !+' +i~i +'+' i I ELSEVIER
U~-T~ASOUND European Journal of Ultrasound 3 (1996) 197-200
Poster-Abstracts Biopsy of thoracic lesions - from CT-controlled to ultrasound guidance
S. Beckh, P.L. B61cskei. Medizinische Klinik 3, Pneumologie, Nfirnberg, Germany
Klinikum
Purpose: Having practised CT-controlled biopsies only, we introduced sonographically guided punctures since 1993 for pulmonary diagnosis. The effects are studied. Methods: In a retrospective study 160 CT-guided biopsies from 1/89 to 9/95 and 46 sonographically guided biopsies from 7/93 to 9/95 have been analysed. Results: By CT, 68% intrapulmonary and 32% pleural, peripheral pulmonary and chestwall lesions were punctured. In 67% a positive diagnosis could be made. 13% of the patients experienced complications, most of them pneumothorax. Thirty-five percent of the patients subject to the sonographic biopsy showed sonographic peripheral pulmonary lesions, 65% tumors of the pleura, pleura and lung, medistinum and chestwall. In 91% a positive diagnosis was obtained. In 2% pneumothorax occured. A positive diagnosis for lesions which would have been visible by CT as well as by ultrasound could be reached with CT in 56%, with ultrasound procedure in 87% of the cases. Conclusion: In diagnosis of pleural, peripheral pulmonary and chestwall lesions, ultrasound guided biopsy is a safe, cost-effective, convenient and accurate method without exposure to X-rays. Ultrasonography in the diagnosis of rib and sternal fracture
R. Bitschnau, O. Gehmacher, A. Kopf, M. Scheier, G. Mathis.
Abteilung fiir Innere Medizin, Krankenhaus Hohenems, Austria Introduction: Lesions of the thoracal sceleton can sometimes present a problem in radiological diagnosis. The aim of the study is to investigate the value of ultrasound at thoracal trauma. Methods: Eighty patients with thoracal trauma and suspected rib fracture or sternal fracture were entered in the study. The results of the thorax X-ray and the thorax sonography were compared. Results: Eighty patients took part in the study (35 women, 45 men, average age of 50.4 years). In the X-ray, the diagnosis of rib fracture was certain in 21 patients (26%), in ultrasound 41 patients (51%) had definitive signs of rib fracture. Because of multiple fractures, 37 ribs could be granted as surely fractured in the X-ray, sonographically 75 fractures could be detected. All of the 6 patients with suspected sternum fracture showed clear fracture signs in X-ray and also in ultrasound. Conclusions: Ultrasonography is an easy, rapidly available and cost-effective method to obtain information in suspected rib/sternum fracture. The diagnosis of rib fracture can be granted about twice as often in ultrasound than in X-ray, clear signs of rib/sternum fracture can be obtained sonographically in a reliable and very sensitive way. US-guided transthoracic puncture of small peripheral lung nodules and left anterior mediastinal masses
J. Verbanck, R. Fabri, P. Bertrand, P. De Muynck, G. Dewaele, P. Dujardin, I. Surmont, W. Tanghe, H. Hartziekenhuis.
0929-8266/96/$15.00 © 1996 Elsevier Science Ireland Ltd. All rights reserved PH S0929-8266(96)00149-8
198
Poster abstracts / European Journal of Ultrasound 3 (1996) 197-200
8800 Roeselare, Belgium We performed a transthoracic ultrasoundguided biopsy in 35 patients presenting a small peripheral lung lesion or a left anterior mediastinal mass, not accessible for, respectively, the fiberbronchoscope or the medaistinoscope. Subsequent histology and for bacteriology revealed malignant cells in 25 patients, infection in 8 patients and benign cells in 2 patients. In the patients with malignancy, the US-guided biopsy was able to establish a specific histological diagnosis making more invasive diagnostic procedures unnecessary. Complications of the procedure, like pneumothorax or bleeding were not observed. We conclude that the US-guided transthoracic biopsy of small peripheral lung or mediastinal lesions is an accurate and safe diagnostic procedure. Sonographic findings in pleuritis O. Gehmacher, A. Kopf, M. Scheier, R. Bitschnau, T. Wertgen, G. Mathis. Krankenhaus Hohenems, Interne Abteilung A 6845 Hohenems, Austria
Objective: The diagnosis of pleuritis is established on clinical findings. A chest x-ray is of limited diagnostic value. It was the aim of this study to examine whether ultrasound can visualize pleural pathology in pleuritis. Methods: 30 patients with the clinically suspected diagnosis of pleuritis were examined with a 7,0 MHZ linear scanner. A pneumonia was excluded by chest x-ray. The following parameters were observed: presence of subpleural consolidation; interruption of the smooth echogenic pleural line; localized pleural effusion; presence of colour doppler signals. Results: The normally smooth and echogenic pleural line was interrupted and inhomogenous in 25 patients. Eighteen cases showed polycyclic and hypoechoic consolidations between 3 mm and 2 cm. Colour doppler signals could be observed in 11 patients. A localized pleural effusion could be seen in 24 cases. This occured mainly during the course of the disease. Aspiration of pleural fluid was performed in 1 patient and confirmed the diagnosis of Tb pleuritis. Conclusion: Sonography of the chest can visualize pleural pathology in
90% of patients with suspected pleuritis. It is a good methode for controlling the course of the disease. Aspiration of pleural fluid for further diagnostic procedures can be performed safely under guidance of ultrasound.
The value of chest sonography in case of different pleural diseases Zs. Gy6ri, E. Vajda, M. Osz. Semmelweis Medical School Budapest, Hungary Authors report different sonographic findings in 521 patients with pleural effusions. All diagnoses were confirmed by aspiration cytology and/or biopsies. Pleural effusions were characterised by their acoustic properties (e.g. echogenic debris, fibrinotic network). The focal and diffused thickenings of the pleura were estimated. The mean causes of pleural effusions were the following: lung cancer, tuberculosis, pneumonic and infarct related effusion, empyema, and transudate. The ratio of benign and malignant cases was 246/275. Pleural sonography cannot give adequate etiological diagnosis, however, the thickening of the pleural wall and the echogenety of fluid collection can be determined at a great extent. It is a valuable guide in the diagnostic and the therapeutical puncture of small and located pleural effusions in the majority of the cases. This method proved to be also very useful before thoracoscopy and in the follow up of patients after pleurodesis.
Chest sonography might be helpful to diagnose pulmonary embolism, a comparison with lung scintigraphy and D-Dimer serum concentrations W. Raneburger, B. Riedl, G. Gamper, A. Theurl, E Benedikt and P. Lechleitner. Division of Internal Medicine, General Hospital Lienz, Austria.
Objective: The aim of the study was to investigate prospectively the diagnostc sensitivity and performance of chest sonography and D-Dimer serum concentration in patients with suspected pulmonary embolism (PE). Patients and methods:
OF
~ !+' +i~i +'+' i I ELSEVIER
U~-T~ASOUND European Journal of Ultrasound 3 (1996) 197-200
Poster-Abstracts Biopsy of thoracic lesions - from CT-controlled to ultrasound guidance
S. Beckh, P.L. B61cskei. Medizinische Klinik 3, Pneumologie, Nfirnberg, Germany
Klinikum
Purpose: Having practised CT-controlled biopsies only, we introduced sonographically guided punctures since 1993 for pulmonary diagnosis. The effects are studied. Methods: In a retrospective study 160 CT-guided biopsies from 1/89 to 9/95 and 46 sonographically guided biopsies from 7/93 to 9/95 have been analysed. Results: By CT, 68% intrapulmonary and 32% pleural, peripheral pulmonary and chestwall lesions were punctured. In 67% a positive diagnosis could be made. 13% of the patients experienced complications, most of them pneumothorax. Thirty-five percent of the patients subject to the sonographic biopsy showed sonographic peripheral pulmonary lesions, 65% tumors of the pleura, pleura and lung, medistinum and chestwall. In 91% a positive diagnosis was obtained. In 2% pneumothorax occured. A positive diagnosis for lesions which would have been visible by CT as well as by ultrasound could be reached with CT in 56%, with ultrasound procedure in 87% of the cases. Conclusion: In diagnosis of pleural, peripheral pulmonary and chestwall lesions, ultrasound guided biopsy is a safe, cost-effective, convenient and accurate method without exposure to X-rays. Ultrasonography in the diagnosis of rib and sternal fracture
R. Bitschnau, O. Gehmacher, A. Kopf, M. Scheier, G. Mathis.
Abteilung fiir Innere Medizin, Krankenhaus Hohenems, Austria Introduction: Lesions of the thoracal sceleton can sometimes present a problem in radiological diagnosis. The aim of the study is to investigate the value of ultrasound at thoracal trauma. Methods: Eighty patients with thoracal trauma and suspected rib fracture or sternal fracture were entered in the study. The results of the thorax X-ray and the thorax sonography were compared. Results: Eighty patients took part in the study (35 women, 45 men, average age of 50.4 years). In the X-ray, the diagnosis of rib fracture was certain in 21 patients (26%), in ultrasound 41 patients (51%) had definitive signs of rib fracture. Because of multiple fractures, 37 ribs could be granted as surely fractured in the X-ray, sonographically 75 fractures could be detected. All of the 6 patients with suspected sternum fracture showed clear fracture signs in X-ray and also in ultrasound. Conclusions: Ultrasonography is an easy, rapidly available and cost-effective method to obtain information in suspected rib/sternum fracture. The diagnosis of rib fracture can be granted about twice as often in ultrasound than in X-ray, clear signs of rib/sternum fracture can be obtained sonographically in a reliable and very sensitive way. US-guided transthoracic puncture of small peripheral lung nodules and left anterior mediastinal masses
J. Verbanck, R. Fabri, P. Bertrand, P. De Muynck, G. Dewaele, P. Dujardin, I. Surmont, W. Tanghe, H. Hartziekenhuis.
0929-8266/96/$15.00 © 1996 Elsevier Science Ireland Ltd. All rights reserved PH S0929-8266(96)00149-8
198
Poster abstracts / European Journal of Ultrasound 3 (1996) 197-200
8800 Roeselare, Belgium We performed a transthoracic ultrasoundguided biopsy in 35 patients presenting a small peripheral lung lesion or a left anterior mediastinal mass, not accessible for, respectively, the fiberbronchoscope or the medaistinoscope. Subsequent histology and for bacteriology revealed malignant cells in 25 patients, infection in 8 patients and benign cells in 2 patients. In the patients with malignancy, the US-guided biopsy was able to establish a specific histological diagnosis making more invasive diagnostic procedures unnecessary. Complications of the procedure, like pneumothorax or bleeding were not observed. We conclude that the US-guided transthoracic biopsy of small peripheral lung or mediastinal lesions is an accurate and safe diagnostic procedure. Sonographic findings in pleuritis O. Gehmacher, A. Kopf, M. Scheier, R. Bitschnau, T. Wertgen, G. Mathis. Krankenhaus Hohenems, Interne Abteilung A 6845 Hohenems, Austria
Objective: The diagnosis of pleuritis is established on clinical findings. A chest x-ray is of limited diagnostic value. It was the aim of this study to examine whether ultrasound can visualize pleural pathology in pleuritis. Methods: 30 patients with the clinically suspected diagnosis of pleuritis were examined with a 7,0 MHZ linear scanner. A pneumonia was excluded by chest x-ray. The following parameters were observed: presence of subpleural consolidation; interruption of the smooth echogenic pleural line; localized pleural effusion; presence of colour doppler signals. Results: The normally smooth and echogenic pleural line was interrupted and inhomogenous in 25 patients. Eighteen cases showed polycyclic and hypoechoic consolidations between 3 mm and 2 cm. Colour doppler signals could be observed in 11 patients. A localized pleural effusion could be seen in 24 cases. This occured mainly during the course of the disease. Aspiration of pleural fluid was performed in 1 patient and confirmed the diagnosis of Tb pleuritis. Conclusion: Sonography of the chest can visualize pleural pathology in
90% of patients with suspected pleuritis. It is a good methode for controlling the course of the disease. Aspiration of pleural fluid for further diagnostic procedures can be performed safely under guidance of ultrasound.
The value of chest sonography in case of different pleural diseases Zs. Gy6ri, E. Vajda, M. Osz. Semmelweis Medical School Budapest, Hungary Authors report different sonographic findings in 521 patients with pleural effusions. All diagnoses were confirmed by aspiration cytology and/or biopsies. Pleural effusions were characterised by their acoustic properties (e.g. echogenic debris, fibrinotic network). The focal and diffused thickenings of the pleura were estimated. The mean causes of pleural effusions were the following: lung cancer, tuberculosis, pneumonic and infarct related effusion, empyema, and transudate. The ratio of benign and malignant cases was 246/275. Pleural sonography cannot give adequate etiological diagnosis, however, the thickening of the pleural wall and the echogenety of fluid collection can be determined at a great extent. It is a valuable guide in the diagnostic and the therapeutical puncture of small and located pleural effusions in the majority of the cases. This method proved to be also very useful before thoracoscopy and in the follow up of patients after pleurodesis.
Chest sonography might be helpful to diagnose pulmonary embolism, a comparison with lung scintigraphy and D-Dimer serum concentrations W. Raneburger, B. Riedl, G. Gamper, A. Theurl, E Benedikt and P. Lechleitner. Division of Internal Medicine, General Hospital Lienz, Austria.
Objective: The aim of the study was to investigate prospectively the diagnostc sensitivity and performance of chest sonography and D-Dimer serum concentration in patients with suspected pulmonary embolism (PE). Patients and methods: