Wildi Stephan M, Hoda Rana S, Fickling William, Schmulewitz Nathan, Varadarajulu Shyam, Roberts Stacey S, Ferguson Brenda, Hoffman Brenda J, Hawes Robert H, Wallace Michael B
Digestive Disease Center and Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Gastrointest Endosc. 2003 Sep;58(3):362-8.
Benign mediastinal cysts, which account for approximately 20% of mediastinal masses, may be diagnostic challenges. Information regarding the use of EUS and EUS-guided FNA in this setting is limited. The aim of this study was to demonstrate the value and potential risks of EUS and EUS-FNA in the diagnosis of mediastinal foregut cysts.
The EUS database of a single tertiary referral center was reviewed for the diagnosis of benign mediastinal cysts. Twenty patients were identified who underwent 23 EUS examinations for suspected mediastinal cysts (n = 4), for follow-up of a known cyst (n = 3), or for a mediastinal mass of unknown origin (n = 16).
In 19 patients, the definite diagnosis of a mediastinal cyst was established by EUS. Twelve cysts appeared anechoic, 6 were hypoechoic, and one anechoic cyst contained small echoic foci. CT (n = 17) or magnetic resonance imaging (n = 1) was performed in 18 cases; only 4 of these were diagnostic of a cyst. In 3 cases, the cyst contents were aspirated by EUS-FNA. In a fourth case, a solid-appearing duplication cyst, misdiagnosed by EUS, was sampled with FNA and core biopsy. This patient developed severe sepsis secondary to mediastinitis 4 days later. Thoracotomy revealed an infected bronchogenic cyst.
EUS provides a minimally invasive approach to the diagnosis of benign mediastinal cysts and may be more accurate than CT or other imaging modalities. Aspiration of suspected cysts should be undertaken with caution, given the risk of infection.
良性纵隔囊肿约占纵隔肿块的20%，可能带来诊断挑战。关于在这种情况下使用超声内镜（EUS）和EUS引导下细针穿刺抽吸活检（EUS-FNA）的信息有限。本研究的目的是证明EUS和EUS-FNA在诊断纵隔前肠囊肿中的价值和潜在风险。
回顾了一家单一三级转诊中心的EUS数据库，以诊断良性纵隔囊肿。确定了20例患者，他们因疑似纵隔囊肿（n = 4）、已知囊肿的随访（n = 3）或不明来源的纵隔肿块（n = 16）接受了23次EUS检查。
19例患者通过EUS确诊为纵隔囊肿。12个囊肿表现为无回声，6个为低回声，1个无回声囊肿含有小的回声灶。18例患者进行了CT（n = 17）或磁共振成像（n = 1）检查；其中只有4例诊断为囊肿性病变。3例患者通过EUS-FNA抽吸了囊肿内容物。在第四例中，一个表现为实性的重复囊肿被EUS误诊，通过FNA和芯针活检进行了采样检查。该患者在4天后因纵隔炎继发严重脓毒症。开胸手术发现为一个感染性支气管源性囊肿。
EUS为诊断良性纵隔囊肿提供了一种微创方法且可能比CT或其他成像方式更准确。鉴于存在感染风险，对疑似囊肿进行抽吸操作时应谨慎。
