Ayşegül ALTUNKESER, Serpil KOÇALİ, Pınar KOŞAR

Toraksta Radyografik Opasitelerin Ultrasonografi İle Değerlendirilmesi

Amaç: Günümüzde radyoloji kliniklerinde en çok istenen inceleme akciğer (AC) grafileridir. AC grafisinde, plevra,mediasten ve diafragma komşuluğunda lokalize dansite artışı olan vakalarda toraks ultrasonografinin (US)katkısıaraştırıp, bulguları bilgisayarlı tomografi (BT) bulguları ile karşılaştırmayı amaçladık. Yöntem ve Gereçler: Akciğer grafisinde radyoopasite saptanan ve kliniğimize yönlendirilen 40 olgu, toraks US ileincelenmiş, sonuçları AC grafisi ve BT bulguları ile karşılaştırılmıştır. Bununla beraber, olgulardan 30'una BT incele- mesi yapılmıştır. US tetkikinde konveks ve lineer trandüser kullanılmıştır. Bulgular: Kırk olgunun 22si çocuktu ve 31i erkekti. Çocukların yaş ortalaması 6, erişkinlerin ise 56 idi. BT yapıl- mayan 10 hastanın tamamı çocuktu ve AC grafisi, US bulguları, klinik ve laboratuvar takiplerine göre 6'sı pnömoni,2'si normal timüs dokusu, 1'i ampiyem ve 1'i de konjenital kalp hastalığı tanısı aldı. Konsolidasyonu olan 26 olgunun22'sinde plevral mayi saptandı. 18 hastada da konsolidasyonun işareti olan sonografik hava ve/veya mukus bronkog- ramı US ile daha net görüldü.Sonuç: Radyoopasitelerin değerlendirilmesinde, özellikle çocuklarda ve plevral mayisi olanlarda toraks ultrasonogra- fisinin akciğer grafisinden sonraki basamak olması gerektiğini düşünüyoruz.

Evaluation With Ultrasonography of Radiographic Opacities of The Thorax

Introduction: Objective: Chest radiography is the most requested examination method in the radiology departmentsnow. We aimed to investigate the contribution of thorax ultrasonography (US) and to compare the US signs withcomputed tomography (CT) in cases with localized density increase at the neighbour of mediastinum, pleura anddiafragma in the chest radiography. Material and Method: Forty patients with radiographic opacity admitted our department were evaluated with throraxUS and signs of it were compared with chest radiography and CT. Along with this, CT examination was performed to30 of them. Convex and lineer transducers were used at the US examination. Results: Twenty two of cases were child and 31 were male. Mean age of children was 6, adults s was 56. All 10 pa- tients without perforrming CT were children, and according to chest radiography, US signs, clinical and laboratoryfollow, 6 of them were diagnosed pneumonia, 2 were normal thymus gland, 1 was empyema, and 1 was congenitalheart disease, respectively. In twenty two of 26 cases with consolidation, pleural fluid was detected. In also 18 patients,sonographic air and/or mucus bronchogram being consolidation sign were more visualised. Conclusion: In evaluation of radioopacity, in especially children and in those with pleural effusion, we think thatthorax ultrasonography must be second method after chest graphy.

PDF

___

1. Tuncel E. Klinik radyoloji 1994. Birinci baskı. Güneş&Nobel1994;sayfa:117-197.
2. Osma. E. Solunum Sistemi Radyolojisi Normal ve Patolojik. Bi- rinci baskı, Ekim 2000.
3. Kim OH, Kim WS, Kim MJ, Jung SY. US in the diagnosis of pedi- atric chest disease, Radiographics. 2000 ;20:653-671.
4. William E. Brant, M.D. İn: Rumack C.M, Wilson S.R, Carbone- au J.W.editors. DiagnosticUtrasound. Mosby, St.Louis, Missouri 1998,pp575-597.
5. Dynes MC, White EM, Fry WA et al. Imaging manifestation of pleural tumors. Radiographics 1992:12:1192-1201
6. Georg C, Schvverk WB, Georg K et al.pleural effüsion: an "acus- tic window "for sonography of pleural metastas. J of Cli- nic Ultrasound1991;19;93-97.
7. Kawashima A, Libshitz HI. Malign pleural mesotelioma: CT ma- nifestation in 50 cases.AJR 1990;155:965-969.
8. Kaya T, Temel Radyoloji Tekniği. 1997 Güneş&Nobel yayınevi
9. Wernecke K, Vassallo P, Pötter R.et al. Mediastinal tumors: Sensi- tivity of detection as compared with CT and radiography. Radio- logy 1990;175:137-143.
10. Wernecke K, Vasalo P, Hoffman G,et al. Value of sonog- raphy in monitoring the terapeutic response of mediastinal lymphoma:comparison with chest radiography and CT. AJR 1991;156:265-272.
11. Mathis G. Thoraxsonography.I.Chest wall and pleura Ultrasound. Med Biol. 1997;23:1131-1139.
12. Ko JC, Yang PC, Chang DB et al. Ultrasonographic evaluation of peridiafragmatic lesions: A prospective study. J Med Ultraso- und1994;2:84-92.
13. Yang PC, Luh KT, Chang DB.et al.Ultrasonographic evaluation of pulmoner consolidation. Am Rev Respir Dis 1992 a ; 146:757-762.
14. Gehmacher O, Mathis G, Kopf A, Scheier M.Ultrasound imaging of pneumonia. Ultrasound med biol. 1995;21:1119-1122.
15. Glasier M, Leithiser RE. Extracardiac chest ultrasonography in in- fant and children:radiographic and clinical implications. The Jour- nal of Pediatrics 1989.
16. Ben-Ami T. MD, O'Donovan JC. Sonography of the chest in child- ren the pediatric chest .Radiologic Clinics of North America 1993; 31 :517-531.
17. 17. Mathis G Lungen-und Pleurasonographie. Berlin;Springer. 1996a.
18. Laing FC, Filly RA. Problems in the application of ultrasonography for the evaluation of pleural opacities. Radiology. 1978;126:2
19. Mathis G Thoraxsonography. II. Peripheral pulmonary consolida- tion. Ultrasound Med Biol. 1997; 23:1141-1153.11-214.
20. Gechmacher O. Ultrasound pictures of pneumonia. Eur J Ultraso- und 1996;3:161-168.
21. Kopf A, Metzler C, Mathis G. Ultrasound in Lung Tuberculosis. Bildgebung-imaging 1994;61 :S2-S12.
22. Yuan A, Yang PC, Chang DB, et al. Ultrasound guided aspiration biopsy for pulmonary tuberculosis with unusual radiographic appearances. Thorax 1993a;48:167-170.
23. Adam EJ, Ignotus Pl. Sonography of the thymus in healthy child- ren; Freguency of visualization, size and appeariance. AJR Am J Roentgenology. 1993; 161:153-155.