Arvind Kumar Chaturvedi MD, Presenter: Nothing to Disclose

Avinash Rao MD, Abstract Co-Author: Nothing to Disclose

Paul R. Goddard MD, Abstract Co-Author: Nothing to Disclose

Dinesh Chandra Doval MD, Abstract Co-Author: Nothing to Disclose

Ashok Kumar Vaid MD, Abstract Co-Author: Nothing to Disclose

pierre-Yves René Marcy DO, Abstract Co-Author: Nothing to Disclose

Pneumothorax is a common complication of transpulmonary FNAB of superior mediastinal masses. Suprasternal approach is an extrapleural and alternate path to access these masses without traversing lung parenchyma. We studied the efficacy of suprasternal angled approach for CT guided FNAB of superior mediastinal masses and compared it with conventional transpulmonary approach for incidence of pneumothorax and diagnostic yield.

26 patients during the period March 2001 to November 2003, who were referred for CT guided biopsy of undiagnosed superior mediastinal masses were subjected to the study. Pre biopsy guiding scans were obtained on a Siemens ARHP or Siemens Emotion Duo CT scanner.After local anaesthesia infiltration a 9cm long 23gz aspiration needle was inserted through the suprasternal notch close to the superior border of the sternum, and directed in an angled manner caudally, posteriorly and to the right or to the left to enter the mass. The needle insertion was achieved in slow motion without breathhold and not as a quick movement as is usually done when traversing through lung. Scans were obtained to confirm the needle tip in the mass before making aspirations. Patients were observed in day care and were released after an Xray chest revealed no pneumothorax. The results were compared with an equal number of cases who had undergone conventional transpulmonary CT guided FNAB for superior mediastinal masses.

Of the cases subjected to suprasternal approach 24/26 had adequate yield for diagnosis as compared to 18/26 in transpulmonary approach(p=0.035). None of the cases of suprasternal approach had pneumothorax as compared to 4 who had pneumothorax in the transpulmonary approach(p=0.034). Patient compliance was better for the suprasternal approach as no breathhold was necessary.

CT guided suprasternal approach for FNAB of superior mediastinal masses offers enhanced diagnostic yield and no risk of pneumothorax as the needle path is extrapleural. No other complications were observed in the current study although a mediastinal haematoma would remain a possibility. Larger multi center studies are necessary to further establish this view.

Chaturvedi, A, Rao, A, Goddard, P, Doval, D, Vaid, A, Marcy, p, Suprasternal Approach for CT-guided FNAB of Superior Mediastinal Masses and Its Comparison with Transpulmonary Approach for Incidence of Pneumothorax and Diagnostic Yield.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4405711.html