In this chapter, you will learn how to recognize some of the most common abnormalities in the abdomen. We will also discuss selected hepatic abnormalities. Chapter 19 , on ultrasound, describes some of the more common biliary and pelvic abnormalities. Barium Studies of the Gastrointestinal Tract CT, ultrasound, and MRI have essentially replaced conventional radiography and, in many instances, barium studies for the evaluation of the…

Soft-tissue calcifications lend themselves to a systematic approach that ties together a diverse group of diseases. Although this chapter focuses primarily on abdominal calcifications, the same principles and approach apply to dystrophic calcification found anywhere in the body. Most soft-tissue calcification occurs in tissue that is already abnormal. Such calcification is called dystrophic calcification. The nature of most calcifications can be determined by examining two of…

Recognition of extraluminal gas is an important finding that can have an immediate effect on the course of treatment. Air is normally not present in the peritoneal or extraperitoneal spaces, bowel wall, or biliary system. Air outside of the bowel lumen is called extraluminal air. For the purposes of this text, the terms “air” and “gas” are used interchangeably. The four most common locations of extraluminal…

In Chapters 13 and 14 , we discussed how to recognize the normal intestinal gas pattern on conventional radiographs and computed tomography (CT). In this chapter, you will learn how to recognize and categorize the four most common abnormal bowel gas patterns and their causes. These patterns of abnormal bowel gas will appear the same whether imaged initially by conventional radiography or by CT scanning. CT…

Introduction to Abdominal and Pelvic CT It is estimated that around 80 million computed tomography (CT) scans of all kinds are performed in the United States each year. Almost 10% of all visits to the emergency department are for abdominal pain of a nontraumatic nature. Many of those patients undergo a CT scan of the abdomen and pelvis performed to detect or clarify their clinical findings.…

Although imaging of the abdomen is now largely performed utilizing computed tomography (CT), ultrasound, (US), or magnetic resonance imaging (MRI), many patients still have “plain films” of the abdomen as a first step before other imaging studies are performed or as a method of following up on findings demonstrated by other modalities. The principles that guide the interpretation of conventional radiographs also apply to the modalities…

This chapter will discuss how to assess heart size, then describe the normal and abnormal contours of the heart on the frontal radiograph, and, finally, illustrate some imaging findings in common cardiac diseases. Recognizing an Enlarged Cardiac Silhouette The cardiac silhouette (“heart shadow”) can appear enlarged on conventional radiographs for three main reasons (arranged in the order in which they will be discussed, not by frequency…

In this chapter, you will learn how to recognize mediastinal masses, benign and malignant pulmonary neoplasms, pulmonary thromboembolic disease, and selected airway diseases. Several chest abnormalities are discussed in other chapters ( Table 11.1 ). A complete discussion of all of the abnormalities imaged in the chest is beyond the scope of this text. We will begin here with mediastinal masses and work our way outward…

Patients in the critical or intensive care units (ICU) are monitored on a frequent basis with portable chest radiography, both to check on the position of their multiple assistive devices and to assess their cardiopulmonary status. Diseases commonly seen in critically ill patients are discussed in other chapters ( Table 10.1 ). TABLE 10.1 Common Diseases in Critically Ill Patients Finding or Disease Discussed in Adult…

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. Most microorganisms that produce pneumonia are spread to the lungs via the tracheobronchial tree, either through inhalation or…

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 ( see Chapter 3 ) . The enfolds of the visceral pleura form the interlobar fissures –the major (oblique) and minor (horizontal) on the right, only…

What Is Atelectasis? Common to all forms of atelectasis is a loss of volume in some or all of the lung, usually leading to increased density of the lung involved. The lung normally appears “black” on a chest radiograph because it contains air. When something of fluid or soft-tissue density is substituted for that air or when the air in the lung is resorbed (as it…

Mrs. Smith, a 66-year-old female, comes into the emergency department with increasing shortness of breath. This is her frontal chest radiograph ( Fig. 6.1 ). Would your preliminary recommendation be bronchoscopy for atelectasis, thoracentesis for a large pleural effusion, or a course of antibiotics for her extensive pneumonia? To be able to treat her correctly, you have to determine the cause of the opacification and the…

We have reviewed the normal imaging anatomy of the heart and lungs in the previous two chapters. Make sure to come back to them for a brush-up whenever needed. Recognizing the difference between normal anatomy and what is abnormal is critical to your ability to make the correct diagnosis. In this chapter, we are going into the realm of the abnormal to examine the major patterns…

Emphasizing conventional radiography first, we will 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). Evaluating the Heart on Chest Radiographs Recognizing a Normal-Sized Heart Important Points You can estimate the size of the…

In this chapter, you will learn the normal anatomy of the lungs as depicted by conventional radiographs and chest CT. To become more comfortable interpreting images of the chest, you should first be able to recognize fundamental, normal anatomy to differentiate it from what is abnormal ( Box 3.1 ). Box 3.1 Which “System” Works Best What is the best system to look at an imaging…

This chapter will enable you to evaluate the technical adequacy of a chest x-ray by helping you become more familiar with the diagnostic pitfalls certain technical artifacts can introduce. This is important so that you don't mistake technical deficiencies for abnormalities. Evaluating the Chest Radiograph for Technical Adequacy Evaluating five technical factors will help you to determine if a chest radiograph is adequate for interpretation or…

This chapter provides a brief introduction to the major imaging modalities. Accompanying most of the modalities is a Case Quiz that uses that modality. A number 2 pencil is not necessary for the quiz. The answers to the quizzes are at the very end of this book. If you do not know the answers to any of the quizzes, that is perfectly fine because you are…