Percutaneous US-guided core biopsy of GI wall lesions is an accurate and safe technique that makes it possible in select cases to obtain a correct pathological diagnosis and prevent unnecessary surgical exploration. Although it has been replaced by EUS-guided biopsy as the procedure of choice to sample submucosal or subserosal GI lesions, US-guided biopsy can still play a useful role in the diagnostic workup of GI lesions when endoscopy or EUS is unsuccessful for various reasons or yields inconclusive cyto-histological results.

rimary chest wall tumors are rare and constitute 1% to 2% of all thoracic tumors. 1 In 15% to 20% of cases, they are asymptomatic neurogenic tumors, 2,3 and their presentation is often that of an incidental finding on chest radiography. 2Magnetic resonance imaging and computed tomography (CT) are commonly used in the diagnostic workup of these lesions.3,4 However, it is often difficult preoperatively to clarify whether they are benign or malignant, 1 and CT-guided needle biopsy can also be nondiagnostic. 3 We report a case in which contrast-enhanced ultrasonography (CEUS) and CEUSguided needle biopsy played a key role in diagnosing a schwannoma of the chest wall. Medicine (G.G., G.T., A.D.G., F.F.) and Pathology (G.Q., S.R.) Received June 4, 2009, from the Section of Interventional Ultrasound (P.T., S.S., S.P.) and Departments of Internal Case ReportA 78-year-old woman was admitted to our department for left-sided chest pain. Physical examination, electrocardiographic, and routine laboratory test findings were normal. Chest radiography showed prominence of the left superior mediastinum; the lung fields were clear. Contrast-enhanced CT of the thorax revealed a 4.5-cm slightly inhomogeneous, weakly enhanced extraparenchymal intrathoracic chest wall mass close to the fourth and fifth dorsal vertebrae (Figure 1). An ultrasonographic examination of the thorax was then performed with tissue harmonic imaging using a real-time ultrasonography system and a 5-MHz convex transducer (MyLab 70XVG; Esaote SpA, Genoa, Italy). Thoracic ultrasonography showed a 4-cm hypoechoic paravertebral mass indenting the pleural line in the fourth and fifth posterior intercostal spaces, with acoustic shadowing from nearby vertebrae in the medial margin (Figure 2).