Ultrasound Ultrasound of of thethe thoracicthoracic wallwallandand axillaaxilla

JeanJean--Yves Meuwly, MDYves Meuwly, MDDepartmentDepartment ofof RadiologyRadiology,, University HospitalUniversity Hospital, , Lausanne, SwitzerlandLausanne, Switzerland

Abdominal and thoracic wallAbdominal and thoracic wall

Normal anatomyNormal anatomy

Normal anatomyNormal anatomy

ThoracicThoracic wallwall: normal : normal anatomyanatomy

ThoracicThoracic wallwall: normal : normal anatomyanatomy

CongenitalCongenital abnormalitiesabnormalities

Bifide Bifide ribsribs

Rib deformities occur Rib deformities occur in 2.8% of in 2.8% of the the populationpopulation

InternalInternal mammarymammary lymphlymph nodesnodes

TumorsTumors of of thethe thoracicthoracic andand abdominal abdominal wallwall

•• BenignBenign–– lipomalipoma–– fibroxantomafibroxantoma–– neurofibromaneurofibroma–– angiomaangioma–– cutaneouscutaneous cystscysts

•• MalignantMalignant–– primaryprimary–– secondarysecondary

SebaceousSebaceous cystcyst

SebaceousSebaceous cystcyst

CutaneousCutaneous tumortumor ??

TurnTurn on on thethe light !light !

FibrousFibrous nodulenodule

LipomaLipoma

LipomaLipoma

LymphangiomaLymphangioma

LymphangiomaLymphangioma

LymphangiomaLymphangioma

T2 T1 FS Gado

LymphangiomaLymphangioma

DesmoidDesmoid tumortumor

DesmoidDesmoid tumortumor

PlasmocytomaPlasmocytoma

PlasmocytomaPlasmocytoma

MetastasisMetastasis

MetastasisMetastasis

LymphomaLymphoma

TumorTumor Invasion of Invasion of thethe ChestChestWallWall in in LungLung CancerCancer

•• AccuraciesAccuracies of US of US andand CT in a CT in a retrospectiveretrospective studystudy•• 120 patients120 patients•• US US criteriacriteria

–– disruption of pleuradisruption of pleura–– extension extension throughthrough thethe chestchest wallwall–– fixation of fixation of tumortumor duringduring breathingbreathing

•• CT CT criteriacriteria–– obtuse angle of obtuse angle of thethe mass mass withwith thethe wallwall–– > 3 cm contact> 3 cm contact–– visible pleural visible pleural thickeningthickening

Suzuki N,Suzuki N, SaitohSaitoh T,T, KitamuraKitamura SS RadiologyRadiology 1993; 187: 391993; 187: 39--4242

TumorTumor Invasion of Invasion of thethe ChestChest WallWallin in LungLung CancerCancer

USUS100 %100 %98 %98 %98 %98 %

CTCT68 %68 %SensitivitySensitivity

SpecificitySpecificityAccuracyAccuracy

66 %66 %67 %67 %

Suzuki N,Suzuki N, SaitohSaitoh T,T, KitamuraKitamura SS RadiologyRadiology 1993; 187: 391993; 187: 39--4242

Small Small pulmonarypulmonary tumortumor

ThoracicThoracic wallwall Invasion?Invasion?

Invasion of Invasion of thethe thoracicthoracic wallwall??

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ltumor

TraumaTrauma

Rib fracture, patient with myelopathy

Sternoclavicular articulationSternoclavicular articulation

Chondrocostal cartilageChondrocostal cartilage

Sternocostal, costochondral and Sternocostal, costochondral and interchodral jointsinterchodral joints

Plane synovial joint Plane synovial joint with articular with articular capsulecapsule

FibrousFibrous joint joint without without articular articular capsulecapsule

CostoCosto--chondralchondral junctionjunction

Sleeping Sleeping ribrib syndromesyndrome

Meuwly JY, Wicky S, Schnyder P, Lepori D. Slipping rib syndrome: a place for sonography in the diagnosis of a frequently overlooked cause of abdominal or low thoracic pain. J Ultrasound Med 2002; 21:339-343.

SternoSterno--costal joint abscess costal joint abscess

AbcessAbcess puncturepuncture

AxillaAxilla

Axillary lymph nodeAxillary lymph node

Axillary lymph nodeAxillary lymph node

US guided biopsyUS guided biopsy

Axillary breast tissueAxillary breast tissue

Axillary breast tissueAxillary breast tissue

Thank you foryour attention