EUS and fine-needle aspiration in the evaluation of mediastinal masses superior to the aortic arch

Background: Mediastinal lesions require a tissue diagnosis. This cannot be obtained with CT-guided biopsy or bronchoscopy in many patients. Co-morbid diseases increase the risk of mediastinoscopy in some of these patients. EUS with fine-needle aspiration (FNA) is frequently used to obtain tissue from the mediastinum, but there have been no case series published of FNA of lesions superior to the aortic arch. Methods: This is the report of a case series of 4 patients with mediastinal masses superior to the aortic arch. EUS with a linear array echoendoscope and FNA were performed to evaluate each lesion. Observations: All 4 patients underwent the procedure without complication, and cytologic material obtained in 3 was diagnostic. One patient had a nondiagnostic aspirate and underwent mediastinoscopy. Conclusions: EUS with FNA is a safe and effective method for tissue diagnosis of mediastinal lesions. Heretofore, mediastinoscopy or transtracheal biopsy was required for diagnosis in patients with lesions superior to the aortic arch. However, for such lesions EUS with FNA appears to be an excellent alternative for establishing a diagnosis.