[Sonography of the neck and superior mediastinum]

Sonography of the neck and superior mediastinum is a very instructive method of investigation. However, the topographical anatomy of the region makes major demands on the investigator. In many diseases in this area, ultrasonography may be used as the first and also only imaging method (thyroid, salivary glands, lymph nodes). Pathological findings are detected with high sensitivity. The dynamic investigation with palpation, compression and observation of deglutition is especially helpful in appraising the consistency, displace-ability and topographical identification of structures. The specificity can be substantially improved by use of color Doppler sonography and ultrasound-guided biopsy. The pharyngeal and retropharyngeal space, the base of the brain and the posterior mediastinum are difficult to access by sonography. The investigator must therefore arrange for supplementary imaging procedures such as CT, MRI or thyroid scintigraphy in unclear cases, e.g. in diagnosis and staging of tumors. Mediastinal space occupations are most frequent in the anterior upper mediastinum. They can be appraised almost as reliably by transthoracic sonography as by computer tomography.