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Recognizing Pneumonia

General Considerations Pneumonia can be defined as consolidation of the lung produced by inflammatory exudate, usually as a result of an infectious agent. Most pneumonias produce airspace disease, either lobar or segmental. Other pneumonias demonstrate interstitial disease and some produce findings in both the airspaces and the interstitium. Case Quiz 8 Question This is a chest x-ray immediately following a diagnostic test the patient was undergoing.…

Recognizing a Pleural Effusion

Normal Anatomy and Physiology of the Pleural Space Normal anatomy The parietal pleura lines the inside of the thoracic cage and the visceral pleura adheres to the surface of the lung parenchyma including its interface with the mediastinum and diaphragm. The enfolds of the visceral pleura form the interlobar fissures —the major ( oblique ) and minor ( horizontal ) on the right, only the major…

Recognizing Atelectasis

What is Atelectasis? Common to all forms of atelectasis is a loss of volume in some or all of the lung, frequently (but not always) leading to increased density of the lung involved. The lung normally appears “black” on a chest radiograph because it contains air. When the air in all or part of the lung is absent because of resorption or compression as in atelectasis,…

Recognizing the Causes of an Opacified Hemithorax

There are three major causes of an opacified hemithorax (plus one other that is less common). They are: Atelectasis of the entire lung A very large pleural effusion Pneumonia of an entire lung And a fourth cause Pneumonectomy— removal of an entire lung Case Quiz 5 Question This 61-year-old heavy smoker presents with cough and shortness of breath. Is the most likely cause of her opacified…

Recognizing Airspace Versus Interstitial Lung Disease

Recognizing the difference between normal anatomy and what is abnormal is critical to your ability to make a correct diagnosis. This chapter begins your exploration into the realm of the abnormal, starting with recognizing patterns of parenchymal lung disease. Case Quiz 4 Question A close-up view of the left upper lobe is shown. Is this most likely airspace disease or interstitial lung disease? Given a history…

Recognizing Normal Cardiac Anatomy

Starting with conventional radiography, we’ll begin with an assessment of heart size, then describe the normal and abnormal contours of the heart on the frontal radiograph and, finally, discuss the normal anatomy of the heart as seen on computed tomography (CT) and magnetic resonance imaging (MRI). Case Quiz 3 Question The image is a frontal chest x-ray of a 52-year-old female with a history of episodes…

Recognizing Normal Pulmonary Anatomy

In this chapter, you’ll learn how to evaluate the normal anatomy ( Fig. 2.1 ) and the technical adequacy ( Fig. 2.2 ) of the lungs on conventional radiography as well as on computed tomography. To become more proficient interpreting images of the chest, you should first be able to recognize fundamental, normal anatomy in order to differentiate it from what is abnormal. Case Quiz 2 Question This…

Recognizing Anything: Past, Present, and Future

This chapter will briefly introduce you to the major imaging modalities: conventional radiography, computed tomography, ultrasound, magnetic resonance imaging, and the use of fluoroscopy. Nuclear medicine has its own online chapter (see e-Appendix A ). In every chapter of this text, there will be a “Case Quiz” based on material in that chapter. The answer to each quiz question can be found in a special box…

Imaging Techniques

ULTRASOUND ANATOMY TECHNIQUE: HEAD Protocol 1 Coronal (15L probe) a Assess extra-axial space and cortex b Assess germinal matrix Anatomic Structures MF – Middle frontal gyrus SFS – Superior frontal sulcus SF – Superior frontal gyrus Cs – Cingulate sulcus CG – Cingulate gyrus CC – Corpus callosum CH – Caudate head LV – Lateral ventricle F – Fornix Pu – Putamen 3rd – Third ventricle * – Germinal matrix Th – Thalamus AH – Amygdala-hippocampus junction UA – Uncal apex CP – Choroid plexus SP – Septum pellucidum FM – Foramen of Monroe F – Fornix 2.Coronal (curvilinear probe) a.Assess overall brain (curvilinear…

Normal Anatomy

LOBAR ANATOMY Anatomic Structures F – Frontal lobe O – Occipital lobe P – Parietal lobe POF – Parietal-occipital fissure S – Sylvian fissure T – Temporal lobe CENTRAL SULCUS Anatomic Structures C – Central sulcus Cs – Cingulate sulcus F – Frontal lobe IPL – Inferior parietal lobule IPS – Intraparietal sulcus Interhemispheric falx (red) M – Marginal sulcus O – Occipital lobe P – Parietal lobe PC – Paracentral lobule PL-Paracentral lobule Po – Postcentral sulcus PO – Postcentral gyrus Pr – Precentral sulcus PR – Precentral gyrus POF – Parieto-occipital fissure SFS – Superior frontal sulcus SPL – Superior parietal lobule FRONTAL LOBE Anatomic Structures AO – Anterior orbitofrontal…

Differential Diagnoses, Summaries, and Imaging Pitfalls

FETAL VENTRICULOMEGALY Isolated Mild Unilateral Ventriculomegaly Brain structurally normal Good prognosis Isolated Bilateral Ventriculomegaly Brain structurally normal Often mild Good prognosis Porencephaly CSF-filled cavity Communicates (usually) with ventricle Ischemia and infection most common causes Hemorrhage Variety of maternal and fetal etiologies May cause hydrocephalus Aqueductal Stenosis Variety of acquired (hemorrhage, infection) and malformative etiologies Severe ventriculomegaly, including the third with normal fourth ventricle Ventricular diverticula Enlarged…

Spine Trauma

INTRODUCTION Background The majority (80%) of pediatric spine trauma occurs in the cervical spine and annual incidence is 1% to 2%. Pediatric spine trauma is most commonly secondary to motor vehicle accidents (52%), sports injury (27%), falls (15%), and nonaccidental trauma (3%). Spinal trauma from nonaccidental injury is more common in children younger than 2 years of age, while sports-related injuries are more common in older…

Infection, Inflammatory, Demyelination, and Vascular Disorders

INTRODUCTION Background Infectious, inflammatory, and demyelinating disorders of the spinal cord are commonly encountered in children. Children typically present with acute neurologic signs and symptoms, including sensory and motor deficits, hyporeflexia or hyperreflexia, and bowel or bladder incontinence. Lumbar puncture is often performed to confirm an infectious, inflammatory, or demyelinating process via demonstration of CSF pleocytosis or the presence of oligoclonal bands. Similar to adults, spinal…

Spine Masses

APPROACH TO SPINE MASSES Key Points Background Spinal masses include those arising from the central nervous system, as well as those arising from other organ systems with either direct extension or systemic spread to the spine. It is important to remember that inflammatory processes such as transverse myelitis can present with mass-like features and congenital malformations such as lipomas or meningoceles can present as a mass.…

Spine Malformations

SPINE MALFORMATION: EMBRYOLOGY AND APPROACH Spine Embryology The formation of the spine occurs from the second to sixth weeks of gestation through: Gastrulation (weeks 2–3): conversion of a bilaminar to trilaminar layer with the middle layer of the mesoderm. Primary neurulation (weeks 3–4): the notochord interacts with the overlying ectoderm to form the neural plate ( Fig. 16.1A ). The neural plate then bends to begin…

Infectious and Inflammatory Disorders of the Head and Neck

INTRODUCTION Background Head and neck infections are extremely common in children. Locations of infections include the lymph nodes, salivary glands, aerodigestive tract, orbit, sinuses, and temporal bone. Consequently, an initial approach to head and neck infections and inflammatory conditions includes appropriate categorization of the anatomic site, followed by determination of extension into adjacent anatomic sites. Complications from spread from one anatomical site can cause significant morbidity…

Neck, Face, Orbit, and Temporal Bone Masses

APPROACH TO NECK MASSES BACKGROUND AND APPROACH TO NECK MASSES Neck masses are commonly encountered in children, and a wide range of etiologies is possible such that familiarity with anatomic locations and a diagnostic approach is necessary in order to arrive at a specific diagnosis or to narrow the differential diagnosis. A particularly helpful approach is to determine whether the mass best falls within categories of…

Temporal Bone Malformations

INTRODUCTION Background Within a space of less than a few centimeters, the temporal bone contains highly specialized small anatomic structures that allow for hearing and balance. The temporal bone is composed of five parts (petrous, tympanic, squamosal, mastoid, and zygomatic) and is subdivided as the inner ear, middle ear, and external ear. The inner ear converts mechanical pressure into electrical signal to provide hearing and balance…

Orbital and Craniofacial Malformations

INTRODUCTION Background Craniofacial malformations have characteristic osseous and soft tissue features, which lead to visible deformity. In addition, these anomalies can lead to loss of normal function of hearing, swallowing, and vision. These malformations frequently involve combinations of craniofacial locations. Several craniofacial malformations have known genetic causes. The most common genetic abnormality involves the fibroblast growth factor. Imaging CT imaging with 3D reconstruction is the modality…

Hydrocephalus and Other Cerebrospinal Fluid Disorders

INTRODUCTION Embryology The ventricles arise from the lumen of the forebrain, midbrain, and hindbrain. At approximately the sixth week of gestation, the lateral ventricles arise as extensions from the anterior-superior aspect of the third ventricle and communicate through the foramen of Monro. The lumen of the hindbrain expands to become the fourth ventricle. The cerebral aqueduct persists in the midbrain and allows communication between the third…