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Consolidation

Airspace consolidation is defined as replacement of gas within the airspaces by fluid, protein, cells, or other material. Consolidation is characterized on radiographs and computed tomography (CT) by the presence of one or more fairly homogeneous opacities associated with obscuration of the pulmonary vessels and little or no loss of volume. Homogeneous opacities that do not obscure the underlying pulmonary vessels are referred to as ground-glass…

Normal Chest Radiography and Computed Tomography

Radiography Technique Projections The standard radiographic views for evaluation of the chest are the posteroanterior (PA) and lateral projections with the patient standing; such projections provide the essential requirement for proper three-dimensional (3D) assessment ( Fig. 1.1 ). In patients who are unable to stand, anteroposterior (AP) upright or supine projections offer alternative but considerably less satisfactory views. The AP projection is of inferior quality because…

The Wrist

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The Elbow

Elbow Checklists 1 Radiographic examination AP External oblique Lateral 2 Elbow joint effusions and the fat pad sign Visible posterior fat pad Elevation of the anterior fat pad, the sail sign 3 Common sites of injury in adults Radial head and neck Olecranon Coronoid process of ulna Distal humerus 4 Common sites of injury in children and adolescents Supracondylar of the distal humerus Salter-Harris type 4…

The Shoulder

Shoulder Checklists 1 Radiographic examination AP external rotation AP internal rotation Axillary view Y-view Grashey (posterior oblique) view 2 Common sites of injury in adults Fractures Midshaft of clavicle Avulsion of the greater tuberosity of the humerus Surgical neck of the humerus Dislocations Acromioclavicular joint dislocation Dislocation of the glenohumeral joint Anterior dislocation Posterior dislocation Luxatio erecti 3 Common sites of injury in children and adolescents…

Peripheral Nerve Imaging: The Carpal Tunnel

The most common peripheral nerve compression syndrome is compression neuropathy of the median nerve at the carpal tunnel. The median nerve innervates the wrist and sends cutaneous sensory branches to innervate the palm, the palmar aspect of the first three digits, and the radial half of the fourth digit. The median nerve also innervates the superficial flexors of the first three rays, as well as the…

Imaging of the Sacral Plexus

The sacral plexus and sciatic nerve are formed within the pelvis from contributions of the ventral nerve roots of L4 through S4. The sciatic nerve originates from the sacral plexus within the pelvis and then exits the pelvis through the greater sciatic foramen. Technical advances in the surface coils and pulse sequences used for MRI now make it possible to display the normal anatomy and pathology…

Imaging of the Brachial Plexus

The brachial plexus is the name given to the plexus of nerves formed by the lower four ventral cervical roots (C5-C8) and the first thoracic ventral root (T1) as they emerge from the spinal cord, intermingle, realign, and emerge from the plexus as defined distal nerves. C4 and T2 may contribute axons to the plexus with little effect on the clinical location of the lesion. The…

Complications of Surgery for Decompression of Spinal Stenosis and Disc Disease

Successful surgery for spondylosis and disc disease relieves the initial symptoms and, for cases in which stabilization is performed, provides solid fusion at the operative site. Complications of surgery can include failure to relieve the symptoms, failure of fusion, and any new problem resulting from the surgery itself. General complications of surgery include thrombophlebitis (2%-3%), pulmonary embolism (1%), and death (0.1%-0.3%). Risks of spinal surgery include…

Vertebral Body Augmentation Procedures: Vertebroplasty and Kyphoplasty

Compression fractures of vertebral bodies affect approximately 750,000 people each year in the United States and up to 25% of postmenopausal women. The leading cause of vertebral compression fractures is osteoporosis, a disease that affects 44 million Americans. Younger patients taking corticosteroids for medical problems such as lupus, asthma, and rheumatoid arthritis may also suffer from osteoporotic compression fractures. Other, less common causes of vertebral body…

Intraoperative Neurophysiologic Monitoring

First described more than 40 years ago, intraoperative neurophysiologic monitoring (IONM) is now used routinely in many surgical procedures that carry risk to the brain, spinal cord, and peripheral nervous system. These include closure of intracranial aneurysms and arteriovenous malformations; resections of intracranial tumors; repair of carotid artery disease; relief of spinal compressions caused by degenerative spondylosis, tumor, or trauma; and treatment of spinal vascular malformations.…

Imaging Preparation for Surgery

The spine and the peripheral nervous system remain diagnostically challenging to image owing to the extensive bony canal, relatively small size of the neural elements, and multiplicity of clinical symptoms. A wide variety of techniques are available for imaging the spine. MRI is the procedure of choice for evaluation of many of the musculoskeletal and neurologic diseases of the spine. The musculoskeletal system includes the vertebral…

Inflammation of the Spinal Cord

Noninfectious inflammatory spinal cord lesions include multiple sclerosis (MS), acute transverse myelitis (ATM), neuromyelitis optica (NMO), neurosarcoidosis, and Guillain-Barré syndrome (GBS). Except for MS, these entities are rare. The disease etiologies are incompletely understood but seem to involve immune system activation as a significant event. Recent discoveries, such as the recognition of a serum autoantibody to the membrane protein aquaporin-4 in patients with NMO, have led…

Inflammation of the Spinal Column

Noninfective inflammations of the vertebral spine can be caused by seronegative spondyloarthropathies or by seropositive rheumatoid arthritis. The seronegative spondyloarthropathies include ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel diseases, and undifferentiated arthritis. ANYLOSING SPONDYLITIS Epidemiology Ankylosing spondylitis is the most frequent seronegative inflammatory spinal disease in adults and the prototype for other members of the spondyloarthropathies. The prevalence of this disorder is…

Infections of the Spinal Cord

SPINAL MENINGITIS Spinal meningitis is infection of the spinal cord, leptomeninges, and subarachnoid space by various pathogens. It is also called infectious arachnoiditis. Epidemiology The incidence of bacterial meningitis is 2 to 3 per 100,000. It occurs most commonly in newborns, in infants aged 3 to 8 months, and in adults at the second and sixth decades. Spinal meningitis occurs less frequently than intracranial meningitis. Clinical…

Infections of the Spinal Column

Spinal infection frequently injures the vertebral bodies, intervertebral discs, paraspinal soft tissues, epidural space, meninges, and spinal cord. Clinically, it is notoriously difficult to differentiate spinal infection from degenerative processes, noninfective inflammatory disorders, and spinal neoplasms. Spinal infections are a common cause of morbidity and mortality, especially in immunocompromised patients. Epidural and intradural extramedullary infections are most often caused by pyrogens. Intramedullary infections are usually caused…

Metabolic Conditions Affecting the Spinal Cord

Metabolic disorders of the spinal cord are less common than metabolic disorders of the brain and peripheral nerves. Such metabolic myelopathies can be secondary to nutritional deficiencies, especially vitamin B 12 deficiency, or to systemic metabolic disorders. VITAMIN B 12 DEFICIENCY Subacute combined degeneration (SCD) of the spinal cord is a symmetric spongy vacuolation and degeneration of myelin that results from deficiency of vitamin B 12…

Metabolic Conditions Affecting the Spinal Column

The skeletal manifestations of metabolic disease are a heterogeneous group of conditions resulting from endocrinopathy, vitamin deficiency, renal tubular dysfunction, and disorders of endogenous metabolism. As a group, they are characterized by altered function of the osteoblasts and osteoclasts or abnormal rates of mineralization. Consequently, there are pathologic changes in the bone mass, the collagen framework of the bone, the degree of bone mineralization, and the…

Spinal Tumors

Spinal tumors comprise a large spectrum of distinct histologic entities that may arise primarily from the spinal cord (intra-axial or intramedullary space), the surrounding leptomeninges (intradural extramedullary space), or the extradural soft tissues and bony structures (extradural space). All three anatomic compartments may also be secondarily affected by metastatic disease from a known or unknown distant primary neoplasm. The same category also includes primary and metastatic…