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…
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)…
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…
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…
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 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…
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 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…
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 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 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…
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…
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…