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The Small Intestine, Mesentery and Peritoneal Cavity

The Duodenum Anatomy and Normal Appearances The duodenum forms the first segment of the small bowel (SB) and measures 20–30 cm in length. The first (superior) part contains the duodenal cap (bulb) that passes superiorly, posteriorly and laterally before turning inferiorly to become the second part. Posteriorly, it is devoid of peritoneum. The second (descending) portion courses inferiorly anterior to the right kidney and posterior to the…

The Stomach

Anatomy The oesophagus meets the stomach at the gastro-oesophageal (or oesophagogastric) junction (OGJ). The OGJ is formed by the lower oesophageal sphincter and the crural diaphragm, creating a barrier against acidic stomach contents. The stomach is divided into the cardia, fundus, body, antrum and pylorus. The medial and lateral curvatures of the stomach are known as the lesser and greater curvatures, respectively. The cardia connects the…

The Oesophagus

Anatomy and Function Anatomy ( Table 19.1 ) The oesophagus is a fibromuscular tube that connects the pharynx in the neck to the stomach in the abdomen, traversing the thorax via the superior and posterior mediastinum. It begins below the cricopharyngeus muscle, at the lower edge of the cricoid cartilage and at the level of C6. In the neck, the oesophagus lies posterior to the trachea.…

Current Status of Imaging of the Gastrointestinal Tract

In this section on abdominal imaging, the imaging approach for investigation of pathological processes of the oesophagus, stomach, small bowel, large bowel, peritoneum, liver, biliary system and pancreas are covered in their respective chapters. In this chapter, the relative merits of different imaging investigations are discussed, with most emphasis being placed on their utility in the acute abdominal pain setting. Issues regarding radiation exposure will be…

The Thoracic Aorta: Diagnostic Aspects

The Normal Aorta The aorta is the main artery delivering oxygenated blood from the left ventricle to all parts of the body. In common with other arteries, it has three histologically distinct layers: an intima consisting of a thin endothelial layer; a media containing an elastic lamella, smooth muscle and connective tissue; and a thin outer adventitia made of connective and elastic tissues also containing nerves,…

Pulmonary Circulation and Pulmonary Thromboembolism

Pulmonary Circulation The function of the pulmonary circulation is both to support the lung's metabolic activities and to engage in gas exchange. The pulmonary circulation should not be considered in isolation but, both anatomically and physiologically, as part of a functional unit which is intimately related to cardiac function and optimised to match ventilation and perfusion. There are many examples of this unique interdependence, including the…

Ischaemic Heart Disease

Introduction Ischaemic heart disease (IHD) is a complex, heterogeneous and incompletely understood disease that is usually caused by underlying coronary artery disease (CAD). Worldwide, it is the single most common cause of death and its frequency is increasing. Although the mortality associated with IHD has declined, due to therapeutic improvements and prevention campaigns reducing the incidence of fatal and non-fatal myocardial infarction, the prevalence of IHD…

Nonischaemic Acquired Heart Disease

Nonischaemic heart diseases (NIHDs) account for nearly half of the cardiac deaths. This group of diseases is extremely heterogeneous, including cardiomyopathies (CMPs), valvular problems, cardiac masses and pericardial disease. Modern noninvasive imaging techniques have increased diagnostic accuracy for all these diseases, with consequent decrease in the number of invasive procedures. Role of Imaging In the past, NIHD diagnosis was based on chest radiography and invasive angiography;…

Congenital Heart Disease: General Principles and Imaging

Introduction Although rare, with an incidence of 8 per 1000 births, congenital heart disease (CHD) has increased in prevalence due to the success of surgical and medical management in childhood. A significant proportion of patients with repaired CHD surviving to adulthood fall under the care of cardiologists outside tertiary centres for congenital cardiac care. Specialist cardiovascular and general radiologists require an understanding of the underlying morphological…

Cardiac Anatomy and Imaging Techniques

Knowledge of the cardiac anatomy is essential for identifying and understanding cardiovascular disease in patients and is therefore important in clinical practice. To date, various imaging techniques such as conventional chest radiography, cardiac magnetic resonance (CMR), computed tomography (CT) and echocardiography are all used to assess aspects of cardiac and vascular anatomy. This chapter contains an overview of the techniques used and provides examples of the…

Airspace Diseases

Introduction Diseases of the air spaces are remarkably common, yet, the radiological approach to diagnosis is often considered challenging. In part, this is because a pattern of airspace opacification is non-specific ( Table 11.1 ). However, at its simplest, this radiological pattern simply indicates that air has been displaced, to a greater or lesser degree, from the lung. In clinical practice, airspace opacification is most commonly…

Thoracic Trauma and Related Topics

Thoracic Trauma Introduction The thorax contains the organs most essential to basic life: namely, the heart, lungs and the largest and most important of the blood vessels. The alveoli of the lungs allow exchange of oxygen and carbon dioxide and the heart and great vessels circulate nutrients, oxygen and carbon dioxide to and from all organs and tissues. Traumatic injury to these structures, more than many…

High-Resolution Computed Tomography of Interstitial and Occupational Lung Disease

The pulmonary interstitium consists of the connective tissue fibres that support the lung. It includes the intralobular interstitium beneath the alveolar epithelium, the interlobular septa and the peribronchovascular interstitium. The term interstitial lung disease (ILD) is used to refer to a group of disorders that mainly affects these supporting structures. The predominant abnormality is usually thickening of the interstitium, which may be due to the accumulation…

Pulmonary Neoplasms

Histopathology All types of lung cancer are related to cigarette smoking, although around 15% of all lung cancers occur in never-smokers. The predominant cell types are small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). NSCLC is divided into two main subtypes, squamous cell carcinoma and adenocarcinoma, although most patients are diagnosed on small biopsies and in around 10% the histological subtype is non-evaluable:…

Pulmonary Lobar Collapse: Essential Considerations

Collapse and atelectasis are terms which are often used synonymously and refer to loss of volume within the lung. In North America, the term collapse is often reserved to denote complete loss of volume within an entire lobe or lung. Atelectasis can be described according to extent (linear, plate-like or subsegmental atelectasis, sublobar and lobar atelectasis) or due to the underlying aetiology: compression or passive atelectasis…

Large Airway Disease and Chronic Airflow Obstruction

Introduction The purpose of this chapter is to review lesions involving the trachea and proximal bronchi, to describe the radiological signs of bronchiectasis and to discuss the role of imaging in obstructive lung disease, a group of diffuse lung diseases associated with chronic airflow obstruction that includes chronic obstructive pulmonary disease (COPD), asthma, and obliterative bronchiolitis. In obstructive lung disease, decreased expiratory flow may be related…

Pulmonary Infection in Adults

Respiratory infections are the most common illnesses occurring in humans and pneumonia is the leading cause of death due to infectious disease and the sixth most common cause of death in the United States. Pneumonia is an acute infection of the pulmonary parenchyma that is associated with at least some symptoms of acute infection, accompanied by the presence of an acute infiltrate on a chest radiograph.…

The Mediastinum, Including the Pericardium

The mediastinum is bounded laterally by the two lungs, anteriorly by the sternum, posteriorly by the vertebrae, superiorly by the thoracic inlet and inferiorly by the diaphragm. Mediastinal Diseases Mediastinal Masses Incidence The true prevalence of mediastinal masses is unknown as most surgical series are biased towards patients requiring surgery and do not include all aneurysms, intrathoracic goitres or lymph node masses in patients with established…

The Chest Wall, Pleura, Diaphragm and Intervention

The Chest Wall Although there are numerous tissues and structures that make up the chest wall, based on their radiographic presentation, its components can be grouped into two major parts: the soft tissues and the bony structures. Chest wall tumours can arise from either component; the approach to and differential of these lesions will be considered separately. Soft Tissues On the chest radiograph the soft tissues…

The Normal Chest

The Lungs Each lung is divided into lobes surrounded by pleura. There are normally two lobes on the left, the upper and lower, separated by the major (oblique) fissure, and three on the right, the upper, middle and lower lobes, separated by the major (oblique) and minor (horizontal) fissures. The fissures are frequently incomplete, particularly medially, containing localised defects which form an alveolar pathway for collateral…