Diagnosis of benign cysts of the mediastinum: The role and risks of EUS and FNA

Stephan M. Wildi, Rana S. Hoda, William Fickling, Nathan Schmulewitz, Shyam Varadarajulu, Stacey S. Roberts, Brenda Ferguson, Brenda J. Hoffman, Robert H. Hawes, Michael B. Wallace

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

Background: 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. Methods: 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). Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)362-368
Number of pages7
JournalGastrointestinal Endoscopy
Volume58
Issue number3
StatePublished - Sep 2003

Fingerprint

Endoscopic Ultrasound-Guided Fine Needle Aspiration
Mediastinal Cyst
Mediastinum
Cysts
Bronchogenic Cyst
Mediastinitis
Thoracotomy
Diagnostic Errors
Tertiary Care Centers
Sepsis
Magnetic Resonance Imaging
Databases
Biopsy
Infection

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Wildi, S. M., Hoda, R. S., Fickling, W., Schmulewitz, N., Varadarajulu, S., Roberts, S. S., ... Wallace, M. B. (2003). Diagnosis of benign cysts of the mediastinum: The role and risks of EUS and FNA. Gastrointestinal Endoscopy, 58(3), 362-368.

Diagnosis of benign cysts of the mediastinum : The role and risks of EUS and FNA. / 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.

In: Gastrointestinal Endoscopy, Vol. 58, No. 3, 09.2003, p. 362-368.

Research output: Contribution to journalArticle

Wildi, SM, Hoda, RS, Fickling, W, Schmulewitz, N, Varadarajulu, S, Roberts, SS, Ferguson, B, Hoffman, BJ, Hawes, RH & Wallace, MB 2003, 'Diagnosis of benign cysts of the mediastinum: The role and risks of EUS and FNA', Gastrointestinal Endoscopy, vol. 58, no. 3, pp. 362-368.
Wildi SM, Hoda RS, Fickling W, Schmulewitz N, Varadarajulu S, Roberts SS et al. Diagnosis of benign cysts of the mediastinum: The role and risks of EUS and FNA. Gastrointestinal Endoscopy. 2003 Sep;58(3):362-368.
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. / Diagnosis of benign cysts of the mediastinum : The role and risks of EUS and FNA. In: Gastrointestinal Endoscopy. 2003 ; Vol. 58, No. 3. pp. 362-368.
@article{c6f8933eefb24695a08b67636a148025,
title = "Diagnosis of benign cysts of the mediastinum: The role and risks of EUS and FNA",
abstract = "Background: 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. Methods: 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). Results: 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. Conclusions: 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.",
author = "Wildi, {Stephan M.} and Hoda, {Rana S.} and William Fickling and Nathan Schmulewitz and Shyam Varadarajulu and Roberts, {Stacey S.} and Brenda Ferguson and Hoffman, {Brenda J.} and Hawes, {Robert H.} and Wallace, {Michael B.}",
year = "2003",
month = "9",
language = "English (US)",
volume = "58",
pages = "362--368",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Diagnosis of benign cysts of the mediastinum

T2 - The role and risks of EUS and FNA

AU - Wildi, Stephan M.

AU - Hoda, Rana S.

AU - Fickling, William

AU - Schmulewitz, Nathan

AU - Varadarajulu, Shyam

AU - Roberts, Stacey S.

AU - Ferguson, Brenda

AU - Hoffman, Brenda J.

AU - Hawes, Robert H.

AU - Wallace, Michael B.

PY - 2003/9

Y1 - 2003/9

N2 - Background: 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. Methods: 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). Results: 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. Conclusions: 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.

AB - Background: 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. Methods: 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). Results: 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. Conclusions: 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.

UR - http://www.scopus.com/inward/record.url?scp=10744229166&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=10744229166&partnerID=8YFLogxK

M3 - Article

C2 - 14528209

AN - SCOPUS:10744229166

VL - 58

SP - 362

EP - 368

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 3

ER -