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Chen CC. Detecting Advanced Esophageal Cancer by Point of Care Ultrasonography. J Med Ultrasound 2024; 32:249-251. [PMID: 39310874 PMCID: PMC11414965 DOI: 10.4103/jmu.jmu_26_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 09/25/2024] Open
Abstract
Esophageal cancer (EC) is the 8th-most common cancer and the 6th-most common cause of death worldwide in 2020. Patients with EC might present with a variety of symptoms, such as chest tightness, retrosternal pain, acid regurgitation, heartburn sensation, dyspnea, cough, recurrent pneumonia, hoarseness, dysphagia, and weight loss, which make early diagnosing EC extremely difficult. Currently, the golden diagnostic tool of EC remains endoscopic biopsy. However, in patient suspected advanced EC, point-of-care ultrasonography (POCUS) could be a first-line screening tool. By three zones of esophageal sonography including esophageal inlet, middle third segment of esophagus just beneath the cardiac chambers, and esophagogastric junction, we could be able to detect sonographic evidence of advanced EC including heterogeneous hyperechoic esophageal mass, loss of normal wall differentiation, and mass effect to adjacent structure such as left atrium. For patients with chest pain, POCUS should be focused on cardiac, adjust mediastinum and lung survey. Here, we present a 73-year-old male presented to the emergency department with retrosternal chest pain for 3 months. POCUS revealed esophageal mass which is also proved by computer tomography and endoscopic biopsy on the same day.
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Affiliation(s)
- Chia-Ching Chen
- Department of Emergency Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
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Wang G, Li X, Li L, Liu D, Sun R, Zhang Q, Geng C, Gong H, Gao X. Clinical value of ultrasonic imaging in diagnosis of hypopharyngeal cancer with cervical lymph node metastasis. Oncol Lett 2019; 18:5917-5922. [PMID: 31788065 PMCID: PMC6865165 DOI: 10.3892/ol.2019.10939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/12/2019] [Indexed: 01/30/2023] Open
Abstract
Clinical value of ultrasonic imaging in diagnosis of hypopharyngeal cancer with cervical lymph node metastasis was investigated. Eighty-nine patients who were diagnosed with hypopharyngeal cancer in Qilu Hospital of Shandong University (Qingdao) from January 2014 to June 2016 were retrospectively analyzed. Sixty-eight patients were diagnosed with hypopharyngeal cancer with cervical lymph node metastasis by pathological sections. Twenty-one patients did not have cervical lymph node metastasis. All the patients were diagnosed by palpation and ultrasound. The lymph node ultrasound images were quantified by computer, and the long/short diameter ratio, the maximum systolic velocity, blood flow resistance of the metastatic and non-metastatic patients were compared. The diagnostic efficacy of palpation and ultrasound was analyzed in the diagnosis of hypopharyngeal cancer with cervical lymph node metastasis. A correlation analysis was carried out between the image features of ultrasound and lymph node metastasis. The long/short diameter ratio, maximum systolic velocity and resistance index of patients with lymph node metastasis were significantly higher than those without lymph node metastasis, with a significant difference (P<0.05). Forty-one patients were diagnosed with lymph node metastasis by palpation, fifty-nine patients were diagnosed with lymph node metastasis by ultrasound. The sensitivity and diagnostic coincidence rate of ultrasound in diagnosis of hypopharyngeal cancer with cervical lymph node metastasis were significantly higher than those of palpation (P<0.05). Statistically significant differences were observed in lymph node internal echo types, medullary echo characteristics, envelope definition, and blood flow distribution characteristics between the metastasis group and the non-metastasis group (P<0.05). Lymph node internal echo was heterogeneous. There was no medulla, and the disordered blood flow in the lymph node predicted lymph node metastasis. Preoperative ultrasound has a high diagnostic value in diagnosis of hypopharyngeal cancer with cervical lymph node metastasis. The diagnostic results of preoperative ultrasound can be used as a reference for the diagnosis and treatment of hypopharyngeal cancer with cervical lymph node metastasis.
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Affiliation(s)
- Guzi Wang
- Department of Ultrasound, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong 266035, P.R. China
| | - Xiaoguang Li
- Department of Ultrasound, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong 266035, P.R. China
| | - Li Li
- Department of Ultrasound, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong 266035, P.R. China
| | - Dayu Liu
- Department of Head and Neck Surgery, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong 266035, P.R. China
| | - Ruijie Sun
- Department of Head and Neck Surgery, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong 266035, P.R. China
| | - Qiu Zhang
- Department of Ultrasound, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong 266035, P.R. China
| | - Chenchen Geng
- Department of Ultrasound, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong 266035, P.R. China
| | - Haitong Gong
- Department of Ultrasound, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong 266035, P.R. China
| | - Xiaoqian Gao
- Department of Ultrasound, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong 266035, P.R. China
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Sharma M, Pathak A, Shoukat A, Rameshbabu CS, Goyal S, Bansal R, Hamza R, Charaya K. EUS of the neck: A comprehensive anatomical reference for the staging of head and neck cancer (with videos). Endosc Ultrasound 2019; 8:227-234. [PMID: 31249169 PMCID: PMC6714487 DOI: 10.4103/2303-9027.260860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The use of EUS has application in the nodal staging of head and neck cancer. The technique and the anatomy of head and neck region using EUS have not been described. EUS from three stations in thoracic esophagus, cervical esophagus, and hypopharynx can allow imaging of head and neck. In this article we describe the normal structures from the three stations. The EUS imaging of head and neck can give relevant and additional information in malignancies of head and neck.
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Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Muzaffarnagar, India
| | - Amit Pathak
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Muzaffarnagar, India
| | - Abid Shoukat
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Muzaffarnagar, India
| | | | - Sumit Goyal
- Department of Oncology, Jaypee Hospitals, Noida, Uttar Pradesh, India
| | | | - Rooby Hamza
- Department of Gastroenterology, MES Medical College, Malappuram, Kerala, India
| | - Kshitij Charaya
- Department of Gastroenterology, Consultant Otolaryngologist, Excel ENT, Meerut, India
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Sharma M, Pathak A, Shoukat A, Somani P. Imaging of spaces of neck and mediastinum by endoscopic ultrasound. Lung India 2016; 33:292-305. [PMID: 27185994 PMCID: PMC4857566 DOI: 10.4103/0970-2113.180866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Endoscopic ultrasound (EUS) of the mediastinum was pioneered by gastroenterologists, and it was taken up by pulmonologists when the smaller-diameter endobronchial ultrasound (EBUS) scope was designed after a few years. The pulmonologists’ approach remained largely confined to entry from the trachea, but they soon realized that the esophagus was an alternative route of entry by the EBUS scope. The new generations of interventionists are facing the challenge of learning two techniques (EUS and EBUS) from two routes (esophagus and trachea). The International Association for the Study of Lung Cancer (IASLC) proposed a classification of mediastinal lymph nodes at different stations that lie within the boundaries of specific spaces. These interventionists need clear definitions of landmarks and clear techniques to identify the spaces. There are enough descriptions of spaces of the neck and the mediastinum in the literature, yet the topic mentioned above has never been discussed separately. The anatomical structures, landmarks, and boundaries of spaces will be important to interventionists in the near future during performances of endosonography. This article combines the baseline anatomy of the spaces with the actual imaging during EUS.
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Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Amit Pathak
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Abid Shoukat
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Piyush Somani
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
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Zhou ZF, Xia CZ, Wu M, Yu LN, Yan GZ, Ren QS, Hu CX, Yan M. Comparison of three methods for the confirmation of laryngeal mask airway placement in female patients undergoing gynecologic surgery. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1212-1220. [PMID: 25748523 DOI: 10.1016/j.ultrasmedbio.2014.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 11/11/2014] [Accepted: 12/02/2014] [Indexed: 06/04/2023]
Abstract
The laryngeal mask airway (LMA) is a supraglottic device that is commonly used to provide lung ventilation during general anesthesia. LMA placement needs to be confirmed to provide adequate lung ventilation. To investigate the feasibility of using ultrasound examination, compared with clinical tests and fiberoptic laryngoscopy, to confirm LMA placement, we performed a clinical study of 64 female patients classified as American Society of Anesthesiologists Physical Status I or II who were scheduled for gynecologic surgery with LMA insertion for airway management. After insertion, placement of the LMA was confirmed by clinical tests, ultrasound examination and fiberoptic laryngoscopy. Of the 64 women, placement was confirmed as acceptable in 89.1% by clinical tests, in 59.4% by fiberoptic laryngoscope assessment and in 67.2% by ultrasound examination. With respect to patients with oropharyngeal leaks classified as high, there were no differences in confirmation of acceptable placement between clinical tests and ultrasound examinations (p = 0.092), but the number of patients determined to have acceptable placement by ultrasound examination was greater than that determined by fiberoptic laryngoscopy (p = 0.034). Thus, ultrasound examination is a superior technique for confirming the seal on the LMA.
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Affiliation(s)
- Zhen-feng Zhou
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chen-zhong Xia
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Meng Wu
- Department of Anesthesiology, YinZhou Hospital Affiliated to Medical School of NingBo University, NingBo, China
| | - Li-na Yu
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guo-zhang Yan
- Department of Anesthesiology, YinZhou Hospital Affiliated to Medical School of NingBo University, NingBo, China
| | - Qiu-sheng Ren
- Department of Anesthesiology, YinZhou Hospital Affiliated to Medical School of NingBo University, NingBo, China
| | - Ci-xian Hu
- Department of Anesthesiology, YinZhou Hospital Affiliated to Medical School of NingBo University, NingBo, China
| | - Min Yan
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Kristensen MS, Teoh WH, Graumann O, Laursen CB. Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae. Insights Imaging 2014; 5:253-79. [PMID: 24519789 PMCID: PMC3999368 DOI: 10.1007/s13244-014-0309-5] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/20/2013] [Accepted: 01/10/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To create a state-of-the-art overview of the new and expanding role of ultrasonography in clinical decision-making, intervention and management of the upper and lower airways, that is clinically relevant, up-to-date and practically useful for clinicians. METHODS This is a narrative review combined with a structured Medline literature search. RESULTS Ultrasonography can be utilised to predict airway difficulty during induction of anaesthesia, evaluate if the stomach is empty or possesses gastric content that poses an aspiration risk, localise the essential cricothyroid membrane prior to difficult airway management, perform nerve blocks for awake intubation, confirm tracheal or oesophageal intubation and facilitate localisation of tracheal rings for tracheostomy. Ultrasonography is an excellent diagnostic tool in intraoperative and emergency diagnosis of pneumothorax. It also enables diagnosis and treatment of interstitial syndrome, lung consolidation, atelectasis, pleural effusion and differentiates causes of acute breathlessness during pregnancy. Patient safety can be enhanced by performing procedures under ultrasound guidance, e.g. thoracocentesis, vascular line access and help guide timing of removal of chest tubes by quantification of residual pneumothorax size. CONCLUSIONS Ultrasonography used in conjunction with hands-on management of the upper and lower airways has multiple advantages. There is a rapidly growing body of evidence showing its benefits. TEACHING POINTS • Ultrasonography is becoming essential in management of the upper and lower airways. • The tracheal structures can be identified by ultrasonography, even when unidentifiable by palpation. • Ultrasonography is the primary diagnostic approach in suspicion of intraoperative pneumothorax. • Point-of-care ultrasonography of the airways has a steep learning curve. • Lung ultrasonography allows treatment of interstitial syndrome, consolidation, atelectasis and effusion.
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Affiliation(s)
- Michael S Kristensen
- Department of Anaesthesia, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Denmark,
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Kraft M, Bruns N, Hügens-Penzel M, Arens C. Clinical value of endosonography in the assessment of laryngeal cancer. Head Neck 2012; 35:195-200. [DOI: 10.1002/hed.22949] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2011] [Indexed: 11/10/2022] Open
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KRISTENSEN MS. Ultrasonography in the management of the airway. Acta Anaesthesiol Scand 2011; 55:1155-73. [PMID: 22092121 DOI: 10.1111/j.1399-6576.2011.02518.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2011] [Indexed: 12/19/2022]
Abstract
In this study, it is described how to use ultrasonography (US) for real-time imaging of the airway from the mouth, over pharynx, larynx, and trachea to the peripheral alveoli, and how to use this in airway management. US has several advantages for imaging of the airway - it is safe, quick, repeatable, portable, widely available, and it must be used dynamically for maximum benefit in airway management, in direct conjunction with the airway management, i.e. immediately before, during, and after airway interventions. US can be used for direct observation of whether the tube enters the trachea or the esophagus by placing the ultrasound probe transversely on the neck at the level of the suprasternal notch during intubation, thus confirming intubation without the need for ventilation or circulation. US can be applied before anesthesia induction and diagnose several conditions that affect airway management, but it remains to be determined in which kind of patients the predictive value of such an examination is high enough to recommend this as a routine approach to airway management planning. US can identify the croicothyroid membrane prior to management of a difficult airway, can confirm ventilation by observing lung sliding bilaterally and should be the first diagnostic approach when a pneumothorax is suspected intraoperatively or during initial trauma-evaluation. US can improve percutaneous dilatational tracheostomy by identifying the correct tracheal-ring interspace, avoiding blood vessels and determining the depth from the skin to the tracheal wall.
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Affiliation(s)
- M. S. KRISTENSEN
- Department of Anaesthesia and Operating Theatre Services 4231; Center of Head and Orthopaedics; Copenhagen University Hospital; Rigshospitalet; Denmark
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