EUS for mediastinal disease

摘要

TECHNICAL ASPECTSEUS is ideally suited to evaluate lesions found in the posterior mediastinum. In general, these lesions were first identified by a chest CT. Electronic radial array EUS of the posterior mediastinum can quickly provide a nearly 360deg view of the posterior mediastinum. Linear-array EUS is ideal for a focused examination with transesophageal FNA.When lung cancer is suspected, the examination will focus on not only the nodal stations but also on infradiaphrag-matic sites of metastatic disease, such as the left adrenal gland and liver. The actual technique of transesophageal EUS evaluation of the mediastinum is relatively easy because of the fixed orientation of the structures. In general, little or no air is needed in the transducer balloon. Suction is constantly applied to remove any luminal air and to keep the transducer pressed against the area of interest. The scope is initially placed into the stomach to look at the left adrenal, liver, and celiac region. The scope is then slowly pulled back to look for periesophageal lymph nodes. The examination often focuses on evaluating the subcarinal space (usually 25-30 cm from the incisors), as well as the posterior aortopulmonic window. If lesions are suspected in the paratracheal area, then the scope can be rotated to identify these. The esophagus is actually quite mobile, and, often, by deflecting the scope tip and torquing the scope, even paratracheal or lesions behind the aorta can be visualized and FNA performed.