Zusammenfassung
Die mediastinalen Strukturen können sowohl mit der Computertomographie als auch mit der Magnetresonanztomographie umfassend dargestellt werden. Mit der Sonographie hingegen lassen sich nur Teile des Mediastinums darstellen. Das obere und mittlere Mediastinum lässt sich mit der Sonographie gut darstellen. Der suprasternale Zugang ermöglicht in 90–95 % der Fälle eine ausreichende Beurteilung. Das hintere Mediastinum, die paravertebrale Region, das Hilum der Lunge und der unmittelbare retrosternale Raum können jedoch nur teilweise über einen transthorakalen Zugang beurteilt werden. Die transthorakale Sonographie kann durch Adipositas, Lungenemphysem, mediastinale Distorsion sowie Wirbelsäulendeformitäten stark behindert werden. Aufgrund des kleinen Schallfensters und der Eindringtiefe sind nur 3,5- und 5-MHz-Sektoren-, konvexe und vektorielle Schallköpfe mit kleinen Aperturen für die sonographische Diagnostik geeignet. Etwa 75 % der klinisch relevanten raumfordernden Massen im Mediastinum des Erwachsenen befinden sich im vorderen und mittleren Mediastinum und sind daher für die sonographische Beurteilung gut zugänglich. Die Vaskularität des Tumors kann durch die kontrastmittelverstärkte Sonographie mit wesentlich höherer Empfindlichkeit und ohne Bewegungsartefakte dargestellt werden. Bei der Beurteilung der supraaortalen, perikardialen, prävaskulären und paratrachealen Regionen hat die Sonographie eine Sensitivität von 90-100% und ist fast so zuverlässig wie die Computertomographie. Im aortopulmonalen Fenster und im subcarinalen Bereich erreicht die Sonographie jedoch nur eine Sensitivität von 82–70 %.
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Blank, W., Heinzmann, A., Annema, J.T. (2022). Mediastinum. In: Mathis, G. (eds) Bildatlas der Lungensonographie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-62409-8_6
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