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Mediastinal Disease

There are many excellent textbooks and articles on the mediastinum. This chapter references these articles and a review of the recent literature as the basis for a discussion of the anatomy, pathology, and radiologic manifestations of mediastinal diseases. Normal Anatomy Comprehensive knowledge of cross-sectional anatomy is required to accurately evaluate mediastinal abnormalities. Interpretation of mediastinal anatomy can be assisted by analyzing computed tomography (CT) images at…

Neoplastic Disease of the Lung

Although most primary pulmonary tumors are carcinomas, a large histologic spectrum of benign and malignant tumors of the lung exist. This chapter reviews the more common neoplasms according to the classification proposed by the World Health Organization (WHO) ( Box 37-1 ). Additionally, to address advances in oncology, molecular biology, pathology, radiology, and surgery this chapter includes the modifications in the histologic classification of lung cancer…

Nonneoplastic Parenchymal Lung Disease

Although many lung disorders can be diagnosed from the plain chest radiograph, its limitations in providing a definitive diagnosis are widely understood. Complicated chest radiographs, the lack of radiographic abnormalities in symptomatic patients, and the limitations of portable chest studies make evaluation of conventional chest films sometimes difficult. Imaging evaluation of parenchymal lung disease is essentially confined to chest radiography, high-resolution computed tomography (HRCT), spiral CT,…

Congenital Abnormalities

Introduction Development of the spine and spinal cord is a complex process determined by an intricate chain of embryologic stages under precise genetic control. Although congenital abnormalities of spine development are frequently classified according to the specific derangement responsible for the anomaly, the pathogenesis of some abnormalities is not well understood. We review these anomalies while classifying them from clinical and imaging perspectives. These include three…

Systemic Diseases Affecting the Spine

A variety of systemic diseases affect the osseous skeleton and therefore the spine. Detection of bone abnormalities with imaging can be challenging with plain film, given that demineralization, a common element of many conditions, requires a 50% decrease in bone mass before it can be detected. Computed tomography (CT) has improved the detection of demineralization, and magnetic resonance imaging (MRI) can enhance the sensitivity and specificity…

Spinal Vascular Diseases

Introduction Spinal vascular diseases consist of spinal vascular malformations, spinal aneurysms, and spinal cord arterial ischemia. They are relatively rare but should be kept in the differential diagnosis for spinal tumors, demyelinations, or compressive myelopathies. As for spinal vascular malformations, there have been various nomenclatures or classifi­cations. Spetzler proposed a classification based on anatomic and pathophysiologic characteristics, and he subdifferentiated extradural arteriovenous fistulae (AVF), intradural dorsal/ventral…

Cystic Lesions

A broad spectrum of cystic lesions can be identified on spine imaging. Multiple etiologies and different imaging characteristics of these lesions make the differential diagnosis a challenging issue for radiologists. Cysts may develop within the spinal canal and may be grouped according to their location as intramedullary, intradural extramedullary, or extradural lesions. This classification is useful in planning treatment, but it is less useful for narrowing…

Spinal Infection

Introduction Spinal infection is a common disease worldwide and is being recognized more often, especially since the introduction of more sophisticated imaging techniques. It may be a primary disease, starting locally as a spinal infection, or secondary to a systemic infection or an infection of the central nervous system. Most patients usually present with subtle and nonspecific clinical symptoms that are difficult to diagnose. Because many…

Spinal Tumors

Introduction Spinal neoplasms are divided into three groups based on their anatomic locations: extradural, extramedullary-intradural, and intramedullary tumors ( Fig. 30-1 ). Extradural tumors include masses in the bones, disks, and paraspinal soft tissues. The majority of spinal tumors (60%) in adults are extradural tumors and are most commonly (90%) metastases of systemic cancer. Extramedullary-intradural tumors include masses originating from the dura/arachnoid and nerves. They are…

Degenerative Disease

Introduction Acute and chronic low back pain is a ubiquitous complaint encountered by primary care physicians throughout the United States, accounting for the second most common symptomatic reason for office visits. Low back pain is the leading cause of disability for patients younger than age 45, resulting in lost time from work and decreased work productivity, with increasing cost expenditures for evaluation and treatment of back…

Spinal Trauma

Imaging studies play a central role in the diagnosis of spinal trauma. The biomechanics, natural history, and treatment methods differ significantly in cervical and thoracolumbar injuries and are therefore addressed separately in this chapter. Multiple classification systems have been developed and continue to evolve. We will focus on the analyses of injury characteristics and will discuss the classification systems that have been evaluated for validity and…

Noninfectious Inflammatory Diseases Affecting the Spinal Cord

Introduction Most noninfectious inflammatory diseases of the spinal cord are autoimmune in nature. Although the number of autoimmune diseases affecting the spinal cord is large, their clinical imaging manifestations are limited, and with few exceptions the most common presentation is transverse myelitis (TM). The typical magnetic resonance imaging (MRI) features of TM ( Fig. 27-1 ) are abnormal high signal on T2-weighted images, often accompanied by…

Imaging of the Head and Neck in the Pediatric Patient

Introduction The old adage that “children are not young adults” is certainly true when evaluating pediatric head and neck lesions. The differential diagnosis of neck masses differs compared to masses that arise in adults. The most common pediatric head and neck lesions are congenital or developmental in origin, followed by inflammatory processes and tumors. This chapter will focus on the congenital/developmental and neoplastic processes; inflammatory lesions…

Larynx

Imaging of the larynx is a challenge. Motion is a constant problem because breathing and swallowing are very difficult to control, particularly in patients with lesions that impinge on the airway. The patient's larynx moves slightly with each breath. Despite the difficulties, imaging can still provide important information regarding potential involvement of deeper soft tissues and cartilage. Imaging must be considered in view of the capabilities…

Cervical Adenopathy and Neck Masses

Classification Cancer of the head and neck, which includes cancers of the larynx, nasal passages and nose, oral cavity, pharynx, salivary glands, buccal regions, and thyroid, is the sixth most frequent cancer worldwide. Neck masses can be grouped into two major types: nodal masses and nonnodal masses. Both types can appear as benign or malignant lesions. Most malignant nonnodal masses are epithelial malignancies of the mucous…

Paranasal Sinuses

Imaging Options and Protocols Computed tomography (CT) and magnetic resonance imaging (MRI) are the primary imaging modalities for assessment of the paranasal sinuses. Both these imaging techniques are far superior to plain radiographs in the evaluation of the sinonasal cavities. Plain radiographs of the paranasal sinuses are limited in their ability to delineate the complex bony anatomy or to characterize sinonasal disease and hence are almost…

Pharynx

Introduction The pharynx is a fibromuscular tube situated directly anterior to the vertebral column. It extends from the skull base to the lower border of the cricoid cartilage. It comprises a group of six muscles that are predominantly responsible for the voluntary act of swallowing: three pharyngeal constrictor muscles (superior, middle, and inferior constrictor muscles) and three vertically oriented muscles (stylo­pharyngeus, salpingopharyngeus, and palatopharyngeus). They are…

Temporal Bone

Embryology and Development of Temporal Bone The ear consists of three major components, the external, middle, and internal ear. Embryologically the ear has a dual development with development of the inner ear structures (internal auditory canal [IAC], cochlea, vestibule, and semicircular canals [SCC]) independent of the middle and external ear structures (ossicles, middle ear air spaces, mastoid antrum, tympanic membrane [TM], external auditory canal [EAC], and…

Orbit

Anatomy The soft tissue structures of the orbit are contained within a bony cavity and include the globe, extraocular muscles, optic nerve–sheath complex, lacrimal apparatus, and various vascular and nerve structures ( Figs. 20-1 to 20-4 ). Bony Anatomy The bony orbit is a conical structure with the apex pointing posteriorly. The orbital roof is composed of the frontal bone and is thinner anteriorly. The medial…

Demyelinating Disease and Leukoencephalopathies

Introduction The white matter of the central nervous system (CNS) is made up of myelinated neuronal axons. Myelin is a dielectric material composed in large part of lipids; it allows for rapid propagation of nerve impulses and is critical for normal development and functioning of the nervous system. Myelination begins early in the second trimester of fetal development and is largely complete by the end of…