From the Guidelines
For supraclavicular swelling, ultrasound is the best initial imaging modality. Ultrasound provides excellent visualization of superficial structures, can differentiate between solid and cystic masses, and allows for real-time assessment of vascular structures and lymph nodes in the supraclavicular region [ 1 ]. It is non-invasive, does not use radiation, and is relatively inexpensive compared to other imaging techniques.
Key Considerations
- If ultrasound findings are concerning or inconclusive, a contrast-enhanced CT scan of the neck and chest would be the next appropriate step, as it can better evaluate deeper structures and potential connections to the thorax.
- CT can also help identify malignancies and their extent, particularly if lymphadenopathy is suspected [ 1 ].
- In cases where soft tissue detail is paramount or neural involvement is suspected, MRI may be considered.
- For patients with suspected inflammatory or metastatic disease, a PET-CT might be beneficial after initial evaluation [ 1 ].
Imaging Modalities
- Ultrasound: initial imaging modality of choice
- CT scan: next step if ultrasound is inconclusive
- MRI: for soft tissue detail or neural involvement
- PET-CT: for suspected inflammatory or metastatic disease The choice of imaging should ultimately be guided by the clinical presentation, patient history, and physical examination findings [ 1 ].
From the Research
Imaging Options for Supraclavicular Swelling
- Computed Tomography (CT) can be used to diagnose lymphoma, but its sensitivity and specificity are lower compared to Positron Emission Tomography-Computed Tomography (PET-CT) 2
- PET-CT is a highly valuable diagnostic tool for lymphoma, with higher sensitivity and specificity than CT and ultrasound 2, 3
- Lymphatic imaging, such as PET-CT, can facilitate the diagnosis of thoracic duct occlusion, a potential cause of intermittent left supraclavicular swelling 4
- Ultrasound can be used to guide supraclavicular brachial plexus block, but its effectiveness may vary depending on the injection technique 5
Diagnostic Value of Imaging Modalities
- The area under the curve (AUC) values for CT, ultrasound, PET-CT, and combination groups were 0.632,0.614,0.793, and 0.859, respectively, indicating the superior diagnostic value of PET-CT and combination groups 2
- The sensitivity and specificity of PET-CT for lymphoma were higher than those of CT and ultrasound, making it a valuable tool for early diagnosis and treatment response assessment 2, 3
Surgical Approaches for Thoracic Outlet Decompression
- The supraclavicular approach is a safe and effective technique for managing thoracic outlet compression, with a high success rate and minimal morbidity 6