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Face

The standard radiographs Midface and Orbit: one or two OM views ; occasionally with a lateral view . Mandible: OPG , preferably with a PA view. Regularly overlooked injuries ▪ Tripod fracture. ▪ Blow-out fracture. ▪ TMJ dislocation. ▪ Mandibular condyle fracture. Abbreviations CT, computed tomography; OM, occipitomental view; OM15/OM30, OM views with 15° or 30° of angulation of the X-ray beam; OPG, orthopantomogram; PA, posterior-anterior;…

Adult skull

Following a head injury the imaging examination of choice is CT . Plain film skull radiography (SXR) has in the main been abandoned or its use radically reduced as a first line imaging test both in children and in adults . A SXR is now limited to: ▪ where national or local guidelines indicate a role within a patient management algorithm; ▪ locations where imaging resources…

Paediatric skull—suspected NAI

A skull X-ray (SXR) continues to have an important role when there is suspicion of non-accidental injury (NAI) in an infant or a toddler . The primary indication for a SXR in these patients is forensic . Be careful: ▪ Accessory sutures are common. ▪ Calling an accessory suture a fracture may lead to an incorrect suggestion of NAI. ▪ Dismissing a fracture as an accessory…

Particular paediatric points

Paediatric Points addressed in other chapters Chapter 3 , pp. 35–46 : Skull—suspected NAI. Chapter 6 , pp. 92–93 : Shoulder. Chapter 7 , pp. 95–114 : Elbow. Chapter 13 , pp. 214–215, 224–226 : Pelvis. Chapter 17 , pp. 298, 304–305 : Foot. Chapter 21 , pp. 350–351, 358–359 : Swallowed foreign bodies. Bones in children are different “A child is not a small adult…

Key principles

Introduction Patients with traumatic injuries can be placed into one of three major groups. The imaging approach will differ between these groups. Polytrauma (in which one injury may be life threatening) ▪ Imaging: Strict local protocols and algorithms utilising early ultrasound (US) and/or multidetector computed tomography (CT). The use of plain film radiology in the Emergency Department (ED) is generally limited . Multiple injuries (none of…

Image-Guided Therapy

Increasing emphasis on tailoring of cancer treatment strategies to individual patients (i.e., personalized medicine) has enabled development of multiple therapeutic options in the management of malignant diseases of the abdomen and pelvis. In particular, in patients with malignant hepatic and renal tumors, organ-directed treatment such as percutaneous ablation, intra-arterial embolic therapies, and targeted radiation therapy have shown considerable promise in improving patient outcome. Although surgical resection…

Response Evaluation Criteria in Solid Tumors, World Health Organization, and Other Response Criteria

Monitoring the response of tumors to treatment has become an integral component of oncologic imaging. Imaging studies play a vital role in objective assessment by quantifying tumor response to a variety of physical and pharmaceutical treatments. Traditionally, therapeutic response has been assessed by conventional methods that involve serial tumor burden measurements according to the World Health Organization (WHO) and Response Evaluation Criteria in Solid Tumors (RECIST)…

Abdominal Wall Hernias

Etiology Abdominal wall hernias, or external hernias (where abdominal contents protrude beyond the abdominal cavity), include inguinal, femoral, umbilical, incisional, spigelian, epigastric, lumbar, and obturator hernias. All abdominal wall hernias consist of a peritoneal sac that protrudes through a weakness or defect in the muscular layers of the abdomen. The defect may be congenital or acquired. Weakness of the transversalis fascia, which is the layer immediately…

Neoplastic and Non-neoplastic Conditions of the Abdominal Wall

Cross-sectional imaging modalities including ultrasonography, computed tomography (CT), and magnetic resonancy imaging (MRI) provide good anatomic detail of the abdominal wall and allow evaluation of pathologic processes in this area. Ultrasonography is frequently used as the first imaging modality to explore a palpable abdominal mass. Non-neoplastic Conditions Abdominal Wall InflamMation, Infection, and Fluid Collection Etiology Inflammatory processes involving the abdominal wall include diffuse edema ( Figure…

Non-neoplastic Conditions of the Peritoneum and Neoplastic Conditions of the Mesentery and Omentum

Non-neoplastic Conditions of the Peritoneum In many of the diseases discussed in this chapter the diagnosis is often initially raised on computed tomography (CT) or magnetic resonance imaging (MRI). However, in most cases, it is not possible to make a categorical diagnosis based on the imaging findings alone and it is necessary to correlate with clinical findings and laboratory tests. In this section we discuss peritoneal…

Peritoneal Fluid Collections, Peritonitis, and Peritoneal Abscess

Peritoneal Fluid Collections Etiology Ascites is the abnormal accumulation of fluid in the peritoneal cavity. There are numerous causes of ascites, including congenital, infective, inflammatory, and neoplastic diseases. In the United States the most common causes are liver disease and malignancy. In many parts of the world, tuberculosis is an important cause. The main causes of ascites and their frequency in the United States are listed…

Imaging of Disorders of the Male Urethra

Trauma Etiology Urethral trauma may result from blunt, penetrating, or iatrogenic injury. The spectrum of urethral injuries includes contusion, partial or complete disruption, and urethral injury and may involve either the anterior or posterior urethral segment. Blunt anterior urethral injuries are commonly associated with perineal straddle injury, whereas posterior urethral injuries are usually a consequence of the shearing forces involved with a pelvic fracture. Penetrating injuries,…

Imaging of Disorders of the Female Urethra

Urethral Diverticulum Etiology A urethral diverticulum is a focal outpouching of urethral tissue into the urethrovaginal space. It is thought to be due to postinflammatory dilatation and rupture of the periurethral glands (of Skene) into the urethra. Most urethral diverticula are acquired and occur in women between their third and sixth decades in age. The estimated prevalence of urethral diverticula is 0.6% to 6% of adult…

Benign and Malignant Testicular Lesions

Benign Testicular Lesions Etiology and Clinical Presentation Benign scrotal or testicular swellings and masses have many etiologies and different clinical presentations, as listed in Tables 78-1 and 78-2 . Of palpable nodules, 31% to 47% are benign at surgery. TABLE 78-1 Causes of Acute Scrotal Swelling Condition Symptoms Signs Comments Torsion Acute onset of severe pain, usually postpubertal Pain not relieved by scrotal elevation, high-riding testis,…

Imaging of the Scrotum

Technical Aspects Scrotal imaging has been one of the undeniable success stories of modern radiology. The scrotum is predominantly imaged for two clinical indications: the painless scrotal mass and the acute scrotum. Both conditions predominantly affect young men in the second through fourth decades of life. Rapid and accurate diagnosis is the goal of all imaging. Among several imaging modalities available, ultrasonography and magnetic resonance imaging…

Penile Trauma and Miscellaneous Penile Lesions

Etiology Penile lesions can be categorized by cause ( Box 76-1 ). Box 76-1 From Bhatt S, Kocakoc E, Rubens DJ, et al: Sonographic evaluation of penile trauma. J Ultrasound Med 2005; 24:993–1000. Penile Pathologic Processes Trauma Blunt trauma Penetrating or sharp trauma Acute bending accident Tumors Inflammation Infections Erectile dysfunction Impotence Priapism Postoperative penis Idiopathic Penile Trauma Penile fracture is usually caused by the exertion of…

Erectile Dysfunction

Etiology Erectile dysfunction manifests clinically most commonly as impotence and less commonly as priapism. The causes of impotence can be psychogenic, endocrinologic, neurogenic, anatomic, infectious, pharmacologic, or vasogenic. Vasogenic causes of erectile dysfunction include venous leak (aging, priapism, congenital, idiopathic) and arterial insufficiency (atherosclerosis, arterial stenosis or occlusion, perineal radiation, iatrogenic). Anatomic causes include phimosis and paraphimosis and fibrous plaques/scarring (from ischemia, Peyronie's disease, scleroderma, and…

Seminal Vesicle Lesions

Imaging Traditionally, the seminal vesicles were evaluated with seminal vesiculography. This has largely been replaced by computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound ( Figure 74-1 ). Computed Tomography The seminal vesicles are of soft tissue attenuation ( Figure 74-2 ). Cysts and small masses that do not deform the seminal vesicle are not well seen. Large masses or inflammatory change associated with infection…

Benign and Malignant Focal Prostate Lesions

Benign Focal Prostate Lesions Etiology Benign focal lesions of the prostate include benign prostatic hyperplasia (BPH) (see Chapter 72 ), congenital cysts, acquired cysts, prostatitis (acute bacterial, chronic bacterial, chronic pelvic pain syndrome [inflammatory and noninflammatory], and asymptomatic prostatitis), prostatic abscess, and prostatic calcification. The National Institutes of Health classification of prostatitis syndromes provides a useful conceptual framework. Categories I and II reflect acute and chronic…

Benign Prostatic Hyperplasia

Etiology Benign prostatic hyperplasia (BPH) is characterized by the increased volume of prostatic stroma and glandular epithelial cells involving the transitional zone and periurethral region of the prostate. Hormones such as androgens (testosterone and dihydrotestosterone [DHT]) and estrogens are thought to play a central role in proliferation of glandular epithelial elements. The neural, endocrine, and immune systems are also implicated in the prostatic tissue remodeling process.…