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Mediastinoscopic Ultrasonography (MUS) as a Surgical Adjuvant in Lung Cancer Staging

  • Michael WolfEmail author
  • Biruta Witte
  • Martin Hürtgen
Chapter

Abstract

The pretherapeutic assessment of the mediastinal T-status of locally advanced lung carcinoma remains an unsolved problem, whereas mediastinal nodal staging can nowadays be performed with high accuracy. Limitations of non-invasive imaging (CT scan and MRI) favour overstaging of the T-category with the result being that patients receive palliative rather than curative intent therapy. On the other hand, principally presuming a lower stage in centrally located lung tumours inevitably results in an increased number of non-curative exploratory thoracotomies. In this dilemma a valid imaging procedure is clearly needed. Using the artificial pretracheal space created during staging mediastinoscopy in order to introduce sterilizable ultrasound probes, we developed mediastinoscopic ultrasonography (MUS) in an attempt to improve the assessment of the T-status of centrally located lung cancer. Among the ultrasound modalities that offer access to the mediastinum, transesophageal echography and MUS complement one another topographically with regard to mediastinal T-staging.

Keywords

Lung Cancer Patient Left Pulmonary Artery Thoracic Surgeon Innominate Artery Ultrasonic Probe 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors wish to thank Dr. Ricarda Lachmann, for the re-examination of the CT scans, as well as Dr. S. Herber, PhD, head of the department of radiology of our hospital, for allowing us to use the CT and MRI imaging used in this article. Furthermore, we would like to thank Mr. Alexander Zitzer for his valuable contribution in graphic design (Fig. 8.2) as well as Mr. Stefan Kup (IT department) for his help in the preparation of the videos.

Supplementary material

Video 8.1

MUS radial probe: the intrapericardial left superior pulmonary vein in cross section near the level of the pericardial reflection. It shows free pulsatile movements. No intrapericardial tumour is seen. UVP = left superior pulmonary vein, Tr.pulm. = pulmonary trunk, r.PA. = right pulmonary artery, VCS = superior vena cava (MP4 437 KB)

Video 8.2

CT scan (axial): lung carcinoma of the middle lobe growing centrally along the right superior pulmonary vein. The tumour encases the roof of the left atrium, where the right pulmonary vein drains into the atrial chamber (AVI 23086 kb) (MP4 98 MB)

Video 8.3

Contrast-enhanced axial MRI: middle lobe tumour with suspected intrapericardial invasion of the right superior pulmonary vein (MP4 1.82 MB)

Video 8.4

Contrast-enhanced sagittal MRI: middle lobe tumour with suspected intrapericardial invasion of the right superior pulmonary vein (MP4 1.31 MB)

Video 8.5

Cine MRI (axial): middle lobe tumour growing centrally along the superior pulmonary vein, reaching the roof of the left atrium (MP4 835 KB)

Video 8.6

Cine MRI (short heart axis): middle lobe tumour growing centrally along the superior pulmonary vein, reaching the roof of the left atrium (MP4 1.25 MB)

Video 8.7

Video MUS convex probe: The superior pulmonary vein is invaded within the pericardial reflection, proven by the crescent-shaped pericardial fluid space seen at the left side of the vessel. Colour Doppler shows the filiform configuration of the invaded vessel. UPV = intrapericardial superior pulmonary vein, PERIC. = pericardial fluid, TU = tumour (MP4 584 KB)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Klinik für ThoraxchirurgieKatholisches Klinikum KoblenzKoblenzGermany

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