Front cover
IFC_Student Consult
Learning Radiology
Copyright page
Dedication
Contributor
Preface
Acknowledgments
Table of Contents
Video Contents
1 Recognizing Anything
An Introduction to Imaging Modalities
From Darkness … Light
Conventional Radiography
The Five Basic Densities
Radiation Dose and Safety
Ionizing Radiation in Radiology
Three Fates of Radiation During an Imaging Procedure
Measurements of Radiation
Biological Effects of Radiation
Types of Biological Effects
Cancer Development
Sources of Radiation for Humans
Relative Radiation Doses of Different Modalities
Practices for Radiation Safety
Special Circumstances
Computed Tomography
Ultrasonography
Magnetic Resonance Imaging
Fluoroscopy
Nuclear Medicine
Terminology
Terminology Conventions Used in This Book
Conventions Used in This Book
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2 Recognizing a Technically Adequate Chest Radiograph
Evaluating the Chest Radiograph for Technical Adequacy
Penetration
Inspiration
Rotation
Magnification
Angulation
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3 Recognizing Normal Pulmonary Anatomy
The Normal Frontal Chest Radiograph
Normal Pulmonary Vasculature
The Normal Lateral Chest Radiograph
Five Key Areas on the Lateral Chest X-Ray (see Fig. 3-3 and Table 3-1)
The retrosternal clear space
The hilar region
The fissures
The thoracic spine
The diaphragm and posterior costophrenic sulci
The posterior costophrenic angles (posterior costophrenic sulci)
Normal CT Anatomy of the Chest
Normal CT Anatomy of the Lungs
The Fissures
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4 Recognizing Normal Cardiac Anatomy
Evaluating the Heart on Chest Radiographs
Recognizing a Normal-Sized Heart
The Normal Cardiac Contours
General Principles
Evaluating the Heart on Cardiac CT
Normal Cardiac CT Anatomy
Five-Vessel Level (Fig. 4-5)
Aortic Arch Level (Fig. 4-6)
Aortopulmonary Window Level (Fig. 4-7)
Main Pulmonary Artery Level (Fig. 4-8)
High Cardiac Level (Fig. 4-9)
Low Cardiac Level (Fig. 4-10)
Uses of Cardiac CT
CCTA—Normal Anatomy
Cardiac MRI
Normal Cardiac MRI Anatomy
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5 Recognizing Airspace versus Interstitial Lung Disease
Classifying Parenchymal Lung Disease
Characteristics of Airspace Disease
Some Causes of Airspace Disease
Characteristics of Interstitial Lung Disease
Some Causes of Interstitial Lung Disease
Predominantly Reticular Interstitial Lung Diseases
Predominantly Nodular Interstitial Diseases
Mixed Reticular and Nodular Interstitial Disease (Reticulonodular Disease)
Mixed Airspace and Interstitial Disease
Tuberculosis
Primary Pulmonary Tuberculosis
Postprimary Tuberculosis (“Reactivation TB”)
Patterns of Distribution of Postprimary Tuberculosis
Miliary Tuberculosis
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6 Recognizing the Causes of an Opacified Hemithorax
Atelectasis of the Entire Lung
Massive Pleural Effusion
Pneumonia of an Entire Lung
Postpneumonectomy
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7 Recognizing Atelectasis
What is Atelectasis?
Types of Atelectasis
Patterns of Collapse in Lobar Atelectasis
How Atelectasis Resolves
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8 Recognizing a Pleural Effusion
Normal Anatomy and Physiology of the Pleural Space
Normal Anatomy
Normal Physiology
Modalities for Detecting Pleural Effusions
Causes of Pleural Effusions
Types of Pleural Effusions
Side-Specificity of Pleural Effusions
Recognizing the Different Appearances of Pleural Effusions
Subpulmonic Effusions
Blunting of the Costophrenic Angles
The Meniscus Sign
Opacified Hemithorax
Loculated Effusions
Fissural Pseudotumors
Laminar Effusions
Hydropneumothorax
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9 Recognizing Pneumonia
General Considerations
General Characteristics of Pneumonia
Patterns of Pneumonia
Lobar Pneumonia
Segmental Pneumonia (Bronchopneumonia)
Interstitial Pneumonia
Round Pneumonia
Cavitary Pneumonia
Aspiration
Localizing Pneumonia
How Pneumonia Resolves
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10 Recognizing Pneumothorax, Pneumomediastinum, Pneumopericardium, and Subcutaneous Emphysema
Recognizing a Pneumothorax
Recognizing the Pitfalls in Overdiagnosing a Pneumothorax
Types of Pneumothorax
Causes of a Pneumothorax
Other Ways to Diagnose a Pneumothorax
Pulmonary Interstitial Emphysema
Recognizing Pneumomediastinum
Recognizing Pneumopericardium
Recognizing Subcutaneous Emphysema
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11 Recognizing the Correct Placement of Lines and Tubes and Their Potential Complications:
Endotracheal and Tracheostomy Tubes
Endotracheal Tubes
Tracheostomy Tubes
Intravascular Catheters
Central Venous (Pressure) Catheters
Peripherally Inserted Central Catheters
Pulmonary Artery Catheters—Swan-Ganz Catheters
Multiple Lumen Catheters—Quinton Catheters, Hemodialysis Catheters
Pleural Drainage Tubes (Chest Tubes, Thoracotomy Tubes)
Cardiac Devices—Pacemaker, AICD, IABP
Pacemakers (Box 11-8)
Automatic Implantable Cardiac Defibrillators
Intraaortic Counterpulsation Balloon Pump
GI Tubes and Lines—Nasogastric Tubes, Feeding Tubes
Nasogastric Tubes
Feeding Tubes (Dobbhoff Tubes)
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12 Recognizing Diseases of the Chest
Mediastinal Masses
Anterior Mediastinum
Thyroid Masses
Lymphoma
Thymic Masses
Teratoma
Middle Mediastinal Masses
Posterior Mediastinal Masses
Neurogenic Tumors
Solitary Nodule/Mass in the Lung
Signs of a Benign Versus Malignant Solitary Pulmonary Nodule
Benign Causes of Solitary Pulmonary Nodules
Bronchogenic Carcinoma
Bronchogenic Carcinomas Presenting as a Nodule/Mass in the Lung
Bronchogenic Carcinoma Presenting with Bronchial Obstruction
Bronchogenic Carcinoma Presenting with Direct Extension or Metastatic Lesions
Metastatic Neoplasms in the Lung
Multiple Nodules
Lymphangitic Spread of Carcinoma
Pulmonary Thromboembolic Disease
Chronic Obstructive Pulmonary Disease
Blebs and Bullae, Cysts and Cavities
Blebs
Bullae
Cysts
Cavities
Bronchiectasis
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13 Recognizing Adult Heart Disease
Recognizing an Enlarged Cardiac Silhouette
Pericardial Effusion
Extracardiac Causes of Apparent Cardiac Enlargement
Identifying Cardiac Enlargement on an Ap Chest Radiograph
Recognizing Cardiomegaly on the Lateral Chest Radiograph
Recognizing Common Cardiac Diseases
Congestive Heart Failure
Pulmonary interstitial edema
Thickening of the Interlobular Septa—The Kerley B Line
Peribronchial Cuffing
Fluid in the Fissures
Pleural Effusion
Pulmonary alveolar edema
Noncardiogenic Pulmonary Edema—General Considerations
Noncardiogenic Pulmonary Edema—Imaging Findings
Differentiating Cardiac from Noncardiac Pulmonary Edema
Hypertensive Cardiovascular Disease
Mitral Stenosis
Pulmonary Arterial Hypertension
Aortic Stenosis
Cardiomyopathy
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Restrictive Cardiomyopathy
Aortic Aneurysms— General Considerations
Recognizing a Thoracic Aortic Aneurysm
Thoracic Aortic Dissection
Coronary Artery Disease
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14 Recognizing the Normal Abdomen: Conventional Radiology
Conventional Radiography
What to Look For
Normal Bowel Gas Pattern
Normal Fluid Levels
Differentiating Large From Small Bowel
Acute Abdominal Series: the Views and What They Show
Supine View (“Scout Film”)
Prone View
Upright View of the Abdomen
Upright View of Chest
Calcifications
Organomegaly
Liver
Spleen
Kidneys
Urinary Bladder
Uterus
Psoas Muscles
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15 Recognizing the Normal Abdomen and Pelvis on Computed Tomography
Introduction to Abdominal and Pelvic Computed Tomography
Intravenous Contrast in CT Scanning
Oral Contrast in CT Scanning
Abdominal CT: General Considerations
Liver
Spleen
Pancreas
Kidneys
Small and Large Bowel
Urinary Bladder
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16 Recognizing Bowel Obstruction and Ileus
Abnormal Gas Patterns
Laws of the Gut
Functional Ileus: Localized Sentinel Loops
Functional Ileus: Generalized Adynamic Ileus
Mechanical Obstruction: Small Bowel Obstruction
Mechanical Obstruction: Large Bowel Obstruction (LBO)
Volvulus of the Colon
Intestinal Pseudoobstruction (Ogilvie Syndrome)
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17 Recognizing Extraluminal Gas in the Abdomen
Signs of Free Intraperitoneal Air
Air Beneath the Diaphragm
Visualization of Both Sides of the Bowel Wall
Visualization of the Falciform Ligament
Causes of Free Air
Signs of Extraperitoneal Air (Retroperitoneal Air)
Causes of Extraperitoneal Air
Signs of Air in the Bowel Wall
Causes and Significance of Air in the Bowel Wall
Signs of Air in the Biliary System
Causes of Air in the Biliary System
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18 Recognizing Abnormal Calcifications and Their Causes
Patterns of Calcification
Rimlike Calcification
Linear or Tracklike Calcification
Lamellar or Laminar Calcification
Cloudlike, Amorphous, or Popcorn Calcification
Location of Calcification
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19 Recognizing the Imaging Findings of Trauma
Chest Trauma
Rib Fractures
Pulmonary Contusions
Pulmonary Lacerations (Hematoma or Traumatic Pneumatocele)
Aortic Trauma
Abdominal Trauma
Liver
Spleen
Kidneys
Shock Bowel
Pelvic Trauma
Rupture of the Urinary Bladder
Urethral Injuries
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20 Recognizing Gastrointestinal, Hepatic, and Urinary Tract Abnormalities
Esophagus
Esophageal Diverticula
Esophageal Carcinoma
Hiatal Hernia and Gastroesophageal Reflux
Stomach and Duodenum
Gastric Ulcers
Gastric Carcinoma
Duodenal Ulcer
Small and Large Bowel
General Considerations
Small Bowel—Crohn Disease
Large Bowel
Diverticulosis
Diverticulitis
Colonic Polyps
Colonic Carcinoma
Colitis
Appendicitis
Pancreas
Pancreatitis
Chronic Pancreatitis
Pancreatic Adenocarcinoma
Hepatobiliary Abnormalities
Liver—General Considerations
Fatty Infiltration
Cirrhosis
Space-Occupying Lesions of the Liver
Metastases
Hepatocellular Carcinoma (Hepatoma)
Cavernous Hemangiomas
Hepatic Cysts
Biliary System
Magnetic Resonance Cholangiopancreatography
Urinary Tract
Kidneys—General Considerations
Space-Occupying Lesions
Renal cysts
Renal cell carcinoma (hypernephroma)
Pelvis
General Considerations
Urinary Bladder
Bladder Tumors
Adenopathy
Lymphoma
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21 Ultrasonography: Understanding the Principles and Recognizing Normal and Abnormal Findings
How It Works
Doppler Ultrasonography
Adverse Effects or Safety Issues
Medical Uses of Ultrasonography
Biliary System
Normal ultrasound anatomy
Gallstones and acute cholecystitis
Bile ducts
Urinary Tract
Normal ultrasound anatomy
Hydronephrosis
Medical renal disease
Urinary bladder
Scrotal ultrasound
Abdominal Aortic Aneurysms
Female Pelvic Organs
Normal US anatomy of the uterus
Uterine leiomyomas (fibroids)
Adenomyosis
Ovarian cysts, tumors, and pelvic inflammatory disease
Normal ovarian anatomy and physiology
Ovarian cysts
Ovarian tumors
Pelvic inflammatory disease
Ascites
Appendicitis
Pregnancy
Ectopic pregnancy
Fetal abnormalities
Molar pregnancy
Vascular Ultrasound
Carotid artery stenosis
Deep venous thrombosis (DVT)
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22 Magnetic Resonance Imaging: Understanding the Principles and Recognizing the Basics
How Magnetic Resonance Imaging Works
Hardware That Makes Up an MRI Scanner
Main Magnet
Coils
Computer
What Happens Once Scanning Begins
Pulse Sequences
Repetition Time and Echo Time
How Can You Identify a T1-Weighted or T2-Weighted Image?
Bright Versus Dark
Suppression
Other Pulse Sequence Types
MRI Contrast Agents: General Considerations
MRI Safety Issues
Claustrophobia
Ferromagnetic Objects
Mechanical or Electrical Devices
Can a Patient with an Implanted Medical Device Undergo an MRI Examination?
Pregnant Patients
Nephrogenic Systemic Fibrosis
Diagnostic Applications of MRI
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23 Recognizing Abnormalities of Bone Density
Normal Bone Anatomy
Conventional Radiography
Computed Tomography and Magnetic Resonance Imaging
The Effect of Bone Physiology on Bone Anatomy
Recognizing a Generalized Increase in Bone Density
Osteoblastic Metastatic Disease
Recognizing a Focal Increase in Bone Density
Carcinoma of the Prostate
Avascular Necrosis of Bone
Paget Disease
Recognizing a Generalized Decrease in Bone Density
Osteoporosis
Hyperparathyroidism
Recognizing a Focal Decrease in Bone Density
Osteolytic Metastatic Disease
Multiple Myeloma
Osteomyelitis
Pathologic Fractures
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24 Recognizing Fractures and Dislocations
Recognizing an Acute Fracture
Recognizing Dislocations and Subluxations
Describing Fractures
How Fractures are Described—by the Number of Fracture Fragments
How Fractures are Described—by the Direction of the Fracture Line (Table 24-4)
How Fractures are Described—by the Relationship of One Fracture Fragment to Another
How Fractures are Described—by the Relationship of the Fracture to the Atmosphere
Avulsion Fractures
Salter-Harris Fractures—Epiphyseal Plate Fractures in Children
Child Abuse
Stress Fractures
Common Fracture Eponyms
Some Easily Missed Fractures or Dislocations
Fracture Healing
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25 Recognizing Joint Disease:
Anatomy of a Joint
Classification of Arthritis
Hypertrophic Arthritis
Primary Osteoarthritis (Also Known as Primary Degenerative Arthritis, Degenerative Joint Disease—DJD)
Secondary Osteoarthritis (Secondary Degenerative Arthritis)
Erosive Osteoarthritis
Charcot Arthropathy (Neuropathic Joint)
Calcium Pyrophosphate Deposition Disease (Pyrophosphate Arthropathy)
Erosive Arthritis
Rheumatoid Arthritis (RA)
Gout
Psoriatic Arthritis
Ankylosing Spondylitis
Infectious Arthritis
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26 Recognizing Some Common Causes of Neck and Back Pain
Conventional Radiography, Magnetic Resonance Imaging, and Computed Tomography
The Normal Spine
Vertebral Body
Intervertebral Disks
Spinal Cord and Spinal Nerves
Spinal Ligaments
Normal MRI Appearance of the Spine
Back Pain
Herniated Disks
Degenerative Disk Disease (DDD)
Osteoarthritis of the Facet Joints
Diffuse Idiopathic Skeletal Hyperostosis
Compression Fractures of the Spine
Spinal Stenosis
Malignancy Involving the Spine
MRI in Metastatic Spine Disease
Spinal Trauma
Jefferson Fracture
Hangman’s Fracture
Burst Fractures
Chance Fracture
Locked Facets
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27 Recognizing Some Common Causes of Intracranial Pathology
Normal Anatomy (Fig. 27-1)
MRI and the Brain
Head Trauma
Skull Fractures
Linear skull fractures
Depressed skull fractures
Basilar skull fractures
Facial Fractures
Intracranial Hemorrhage
Epidural Hematoma (Extradural Hematoma)
Subdural Hematoma (SDH)
Intracerebral Hematoma (Intracerebral Hemorrhage)
Diffuse Axonal Injury
Increased Intracranial Pressure
Cerebral Edema
Stroke
General Considerations
Ischemic Stroke
Hemorrhagic Stroke
Ruptured Aneurysms
Hydrocephalus
Obstructive Hydrocephalus
Normal-Pressure Hydrocephalus
Cerebral Atrophy
Brain Tumors
Gliomas of the Brain
Metastases
Meningioma
Vestibular Schwannoma (Acoustic Neuroma)
Other Diseases
Multiple Sclerosis
Neuroimaging Terminology
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28 Recognizing Pediatric Diseases
Conditions Discussed in This Chapter
Newborn Respiratory Distress
Transient Tachypnea of the Newborn
Respiratory Distress Syndrome of the Newborn (Hyaline Membrane Disease)
Meconium Aspiration Syndrome
Bronchopulmonary Dysplasia (Chronic Respiratory Insufficiency of the Premature)
Childhood Lung Disease
Reactive Airways Disease/Bronchiolitis
Asthma
Pneumonia
Soft Tissues of the Neck
Enlarged Tonsils and Adenoids
Epiglottitis
Croup (Laryngotracheobronchitis)
Ingested Foreign Bodies
Other Diseases
Recognizing Cardiomegaly in Infants
Salter-Harris Classification of Epiphyseal Plate Fractures in Children
Child Abuse
Necrotizing Enterocolitis
Esophageal Atresia with/without Tracheoesophageal Fistula (TEF)
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Nuclear Medicine:
How It Works
Radioactive Decay
Half-Life
Nuclear Medicine Equipment
Detecting and Measuring the Radioactivity of an Isotope
Nuclear Medicine Safety
Commonly Used Nuclear Medicine Studies
Bone Scanning
Metastases to Bone
Osteomyelitis
Pulmonary Ventilation/Perfusion Scans for Pulmonary Embolism
Cardiac Scanning
Myocardial Perfusion Scanning
Wall Motion
Thyroid Scintigraphy
Biliary Scanning
HIDA Scans
GI Bleeding Scans
Positron Emission Tomography (PET)
Uses of PET Scans
Safety Issues and PET Scans
PET Scan Images
The ABCs of Heart Disease:
Heart Size
Cardiac Contours—Ascending Aorta
Cardiac Contours—“Double Density” of Left Atrial Enlargement
Cardiac Contours—Right Atrium
Cardiac Contours—Aortic Knob
Cardiac Contours—Main Pulmonary Artery
Cardiac Contours—Concavity for Left Atrium
Cardiac Contours—Left Ventricle
Cardiac Contours—Descending Aorta
The Pulmonary Vasculature—Normal
Pulmonary Vasculature—Pulmonary Venous Hypertension
Pulmonary Vasculature—Pulmonary Arterial Hypertension
Pulmonary Vasculature—Increased Flow to the Lungs
Pulmonary Vasculature—Decreased Flow to the Lungs
The Abcs of the Heart Disease System
Is the Left Atrium Enlarged?
Is the Main Pulmonary Artery Big or Bulbous?
Is the Main Pulmonary Artery Segment Concave?
Is the Heart a Dilated or Delta-Shaped Heart?
Other Facts
The Abcs of Heart Disease in Schematic Form
Appendix What to order when
Bibliography
Texts
Journal Articles
Chapter 1 Quiz Answers
Appendix Unknown Cases: Additional Information
Introduction
Acute Subdural Hematoma
Explanation
General considerations
Clinical findings
Imaging findings
Differential diagnosis
Treatment
References
Anterior Dislocation of the Shoulder
Explanation
Dislocation of the shoulder
Complications
Reference
Boerhaave Syndrome
Explanation
General considerations
Boerhaave syndrome
Imaging findings
Method of study
Reference
Cardiogenic and Noncardiogenic Pulmonary Edema
Explanation
General considerations
Pathophysiology
Causes
Clinical findings
Imaging findings
Differential diagnosis
Treatment
Reference
Central Venous Catheter in Pleural Space
Explanation
Critical care lines and tubes
Tracheostomy
Intravascular lines
Pulmonary artery catheters
Pleural drainage tubes
Cardiac devices
GI tubes and lines
Reference
Child Abuse
Explanation
General considerations
Clinical findings
Sites of skeletal trauma
Appearances of skeletal trauma
Head trauma (13% to 25%)
Viscera (3%)
Differential diagnosis of child abuse
Reference
Dissecting Aortic Aneurysm
Explanation
General considerations
Predisposing factors
Aneurysm defined by size criteria
Vessels involved with dissection
Types
Clinical findings
Imaging findings
Diagnosis
Prognosis
Reference
Epiglottitis
Explanation
General considerations
Clinical findings
Imaging findings
Differential diagnosis
Treatment
Complications
Reference
Flail Chest
Explanation
General considerations
Clinical findings
Imaging findings
Treatment
Complications
Prognosis
Reference
Free Intraperitoneal Air (Pneumoperitoneum)
Explanation
Etiologies
Imaging findings
Reference
Hangman’s Fracture of C2 (Traumatic Spondylolisthesis)
Explanation
General considerations
Clinical findings
Imaging findings
Treatment
Prognosis
References
Intussusception
Explanation
General considerations
Etiology/pathophysiology
Epidemiology
Clinical findings
Imaging findings
Treatment
Reference
Ischemic Stroke
Explanation
General considerations
Clinical findings
Imaging findings
Treatment
Prognosis
Reference
Jefferson Fracture
Explanation
General considerations
Mechanism
Associated injuries
Clinical findings
Imaging findings
Treatment
Reference
Large Pleural Effusion
Explanation
General considerations
Subpulmonic effusion
Laminar effusion
Loculated effusion
Pseudotumor of the lung
Reference
Malpositioned Dobbhoff Tube in Right Lower Lobe
Explanation
Dobbhoff feeding tubes
Reference
Malpositioned Endotracheal Tube
Explanation
General considerations
Reference
Mechanical Small Bowel Obstruction
Explanation
General considerations
Causes
Clinical findings
Imaging findings
Treatment of small bowel obstruction
Reference
Pneumococcal Pneumonia
Explanation
Gram positive pneumonias
Gram-negative pneumonias
Reference
Pneumomediastinum
Explanation
Pneumomediastinum
Clinical findings
Imaging findings of pneumomediastinum
Reference
Rigler Sign Free Air
Explanation
General considerations
Clinical findings
Imaging findings
Differential diagnosis
Reference
Salter Iii Fracture of Capitellum
Explanation
General considerations
Salter-Harris I fractures
Salter-Harris II fractures
Salter-Harris III fractures
Salter-Harris IV fractures
Salter-Harris V fractures
Clinical findings
Imaging findings
Complications
Reference
Sigmoid Volvulus
Explanation
General considerations
Pathophysiology
Clinical findings
Differential diagnosis
Complications
Treatment
Reference
Subarachnoid Hemorrhage
Explanation
General considerations
Causes of subarachnoid hemorrhage (SAH)
Risk factors
Clinical findings
Imaging findings
Treatment
Complications
Prognosis
Reference
Tension Pneumothorax
Explanation
Types of pneumothorax
Imaging findings in pneumothorax
Radiographic signs in upright position
Radiographic signs in supine position
Reference
Unknown Cases Quiz
Question 1
Question 2
Question 3
Question 4
Question 5
Question 6
Question 7
Question 8
Question 9
Question 10
Question 11
Question 12
Question 13
Question 14
Question 15
Question 16
Question 17
Question 18
Question 19
Question 20
Question 21
Question 22
Question 23
Question 24
Question 25
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
IBC_Clinical Key page