Ultrasound evaluation of diaphragmatic dysfunction

1. Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil. Mailing address: Dr. Fabiano Reis. Unicamp – Radiologia. Rua Tessália Vieira de Camargo, 126, Cidade Universitária. Campinas, SP, Brazil, 13083-887. E-mail: [email protected]. The majority of ES/ETs are diagnosed during the first two decades of life. The most common soft tissue sites are the chest wall, lower extremities, and pelvis/hip region. They are rarely found in the retroperitoneum, upper extremities, or internal organs. Patients often present with a painless mass or vague abdominal or chest pain, depending on tumor site. Muscle weakness can also be the predominant symptom. There are certain red flags that should always be considered in the differential diagnosis of patients with focal neurological manifestations of myelopathy and radiculopathy. Although rare and having no specific radiological findings, ES/ET should be suspected in young adults presenting with a large heterogeneous mass in the trunk, extremities, or soft tissues. In the case presented here, an MRI finding of a large mass with isointense solid components on T1and T2-weighted images, together with necrosis and hemorrhage, facilitated the diagnosis in this intriguing case. In addition, ES of the retroperitoneum is difficult to differentiate from other tumors. The retroperitoneal tumors that can invade the neural foramen and vertebral canal are the following: ganglioneuroma and ganglioneuroblastoma; neuroblastoma in younger patients (mean age, 22 months); leukemia (chloroma); and lymphoma. Invasion of the renal vein, inferior vena cava, and liver can be seen in ES, renal cell carcinoma, and adrenocortical carcinoma. Differentiation aspects that favor the diagnosis of ES are earlier age of presentation, absence of metastatic lymphadenopathy, and absence of calcifications. ES tends to be unilateral and does not cross midline. The definitive diagnosis can be made only by histopathological analysis.