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Recognizing Airspace Versus Interstitial Lung Disease

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…

Recognizing Normal Cardiac Anatomy

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…

Recognizing Normal Pulmonary Anatomy

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…

Recognizing a Technically Adequate Chest Radiograph

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…

Hernias and Abdominal Wall Pathology

Abdominal wall disorders are frequently encountered in clinical practice, and may be associated with significant morbidity. Most abdominal wall or groin hernias can be easily diagnosed by inspection and palpation. In these cases, radiologic examinations are useful for preoperative demonstration of the hernia’s contents and associated complications. In many instances, small and reducible hernias are discovered incidentally during gastrointestinal barium studies or multidetector computed tomography (MDCT)…

Mesenteric and Omental Lesions

Primary Neoplasms Primary tumors arising from the peritoneum are rare and are usually of mesenchymal origin. DESMOID TUMORS These tumors are related to benign but locally aggressive fibroblast proliferation or fibromatosis. The morbidity associated with these tumors is related to their locally aggressive behavior with involvement of adjacent organs. They are uncommon, occurring in 2 to 4 per million people per year, and do not show…

Ascites and Peritoneal Fluid Collections

Introduction Ascites is the pathologic accumulation of fluid in the peritoneal cavity. It is a common finding that can be associated with a large number of diseases. Imaging plays an important role in detecting and characterizing ascites. Although ascites may merely reflect generalized third-space fluid loss in conditions such as congestive heart failure, it is more commonly related to intra-abdominal factors that produce peritoneal fluid more…

Pathways of Abdominal and Pelvic Disease Spread

Traditionally, the abdominal cavity has been divided into a number of peritoneal, retroperitoneal, and extraperitoneal spaces. Although it is useful for learning abdominal anatomy and appreciating the confinement of disease in a particular space, this classic approach affords limited understanding of the intra-abdominal spread of disease. Dissemination of disease between the retroperitoneum and the peritoneal cavity, between the subdivisions of the retroperitoneum, and within the subperitoneal…

Splenic Trauma and Surgery

Splenic Trauma The spleen is the most commonly injured organ in blunt abdominal trauma. , It receives 5% of the cardiac output, accounts for 25% of the total reticuloendothelial cell mass, and plays a major role in clearing the plasma antigens. Recognition of this fundamental role in the immune response during the last century has led to greater efforts to preserve the spleen after injury. Nonoperative…

Benign and Malignant Lesions of the Spleen

Although it is affected by many diseases, the spleen is not considered a great challenge to the radiologist. In daily practice, the size and shape of the spleen typically are subjectively evaluated, and if there is no obvious splenomegaly or focal abnormality, the spleen usually is ignored. However, when abnormalities are detected, the radiologist plays an important role in providing a diagnosis and directing further clinical…

Pancreatic Trauma and Surgery

Pancreatic Trauma Traumatic injury to the pancreas is rare and difficult to diagnose. The retroperitoneal location of the pancreas is a mixed anatomic blessing in patients with abdominal trauma. Its fixed position anterior to the vertebral column provides excellent protection against deceleration injury and posterior stab wounds. This protected environment, however, can be breached by bullets and more severe deceleration forces that may cause life-threatening pancreatic…

Pancreatic Neoplasms

Introduction Benign, borderline, and malignant neoplasms can arise from exocrine, endocrine, intraductal, and stromal elements within the pancreas. Additionally, secondary (metastatic) neoplasms and non-neoplastic tumor-like conditions (e.g., mass-forming chronic pancreatitis) can occur. The World Health Organization (WHO) recognizes over 50 types of pancreatic neoplasms. However, only a few of these (adenocarcinoma, cystic neoplasms, pancreatic neuroendocrine tumors [PNETs], and metastases) are encountered with any frequency in clinical…

Pancreatitis

Pancreatitis is one of the most complex and clinically challenging of all abdominal disorders. It remains a major diagnostic challenge because its clinical manifestations are as protean as its causes. Indeed, only one in five severe cases of acute pancreatitis is recognized to be severe at initial presentation, and 42% of fatal cases of acute pancreatitis do not have a correct diagnosis before autopsy. Since the…

Hepatic Trauma and Surgery

Hepatic Trauma CLASSIFICATION OF HEPATIC TRAUMA The management of hepatic trauma patients has evolved significantly during the last three decades and is now based on well-defined treatment algorithms. This has highlighted the need for an accurate classification system as a basis for the clinical decision-making process. Fundamental to the development of these classification schemes and the subsequent treatment algorithms based on them is the widespread availability…

Vascular Disorders of the Liver and Splanchnic Circulation

The liver has a unique, dual blood supply in which 25% of the flow comes from the hepatic artery and 75% through the portal vein. There is an inverse relationship between these two blood supplies. If portal flow decreases, arterial flow will increase as if an impedance has been removed. In addition, there are several communications between these vessels that open in response to nervous and…

Diffuse Liver Disease

The liver has quite accurately been called the custodian of the milieu intérieur, and is vulnerable to a variety of metabolic, vascular, toxic, infectious, and neoplastic insults. Diffuse liver disease can be diagnostically challenging because of nonspecific and overlapping clinical signs and symptoms or even asymptomatic disease. The ability to assess liver and spleen size and the presence of ascites is limited on physical examination. Liver…

Focal Hepatic Infections

Technologic advances have significantly enhanced the role of radiology in the detection, characterization, and management of focal infectious diseases of the liver. Today, all cross-sectional techniques allow highly accurate detection of focal hepatic infections. Computed tomography (CT) is particularly helpful in revealing the presence of calcifications and gas and in detailing the enhancement pattern. With its multiplanar capacity and sensitivity to small differences in tissue composition,…

Malignant Tumors of the Liver

Primary malignant neoplasms of the liver are classified by the cell of origin ( Box 54.1 ). Secondary malignant liver tumors are metastases and lymphomas. Overall, metastases are the most frequent malignant tumors of the liver, except in patients with preexisting cirrhosis, in whom primary malignant neoplasms are more frequent. In this chapter, primary malignant liver tumors of hepatocyte origin are discussed first: hepatocellular carcinoma (HCC),…

Benign Tumors of the Liver

Hemangioma Hemangioma is the most common benign tumor of the liver, with a reported incidence ranging from 1% to 20% ( Table 53.1 ). , Hemangiomas occur primarily in women (female-to-male ratio of 5:1). Although hemangiomas may be present at all ages, they are seen more commonly in postmenopausal women. The worldwide prevalence of this tumor is fairly uniform. In a study of Vilgrain and colleagues,…