Bones appear white on an x-ray film because photoelectric absorption of x-rays is greater in bone than in soft tissue as a result of the higher atomic number of bone. These drugs alter the intestinal flora, resulting in an overgrowth of Clostridium difficile, which releases a toxin(s) that produces the inflammatory pseudomembranes and other pathologic changes. A mobile x-ray generator is typically not as powerful as a fixed x-ray generator, and longer exposure times therefore are necessary to obtain sufficient exposure. Crohn disease is an inflammatory disorder of the gastrointestinal tract of unknown etiology. Multiple pulmonary nodules may also be due to infectious disease, most commonly fungal or mycobacterial infections. The two most common polypoid lesions of the colon are the hyperplastic and neoplastic polyp. Although this tumor (*) could be seen on the CT scan, on the MR image it is far more obvious and more easily distinguished from normal tissue. These lesions are hamartomatous tumors of mesenchymal origin that are usually well differentiated and benign. Hoboken, NJ: Wiley-Blackwell; 2009. For definitive proof, delve into the patient’s film folder. An effusion is typically present and can be identified by ultrasound or MR imaging. Imaging characteristics include increase in T1 hypointensity and T2 hyperintensity, along with variable enhancement in the intervertebral disk and adjacent vertebral body as seen in Case 13-11, Figure 13-27. which is one reason for choosing an anode made of tungsten, with a very high melting point. I discovered this ebook from my i and dad suggested this pdf to find out. Figure 12-3. LANGE Clinical Science Gopal B. Saha This book is an ideal text on PET imaging technology that focuses on the basics, such as physics, instrumentation, production of PET radionuclides and radiopharmaceuticals, and regulations affecting PET. Metastatic disease to the brain has a variety of 352 PART 5 HEAD AND SPINE manifestations, the most common being parenchymal involvement. Lateral view of the elbow with anterior (arrowheads) and posterior (arrow) fat pad signs. Stroke is a lay term for neurologic dysfunction. What is the most likely diagnosis of this soft-tissue mass (arrows) in Case 8-11 (Figure 8-20)? PLAIN FILM OF THE ABDOMEN C CHAPTER 8 231 D Figure 8-50. A radiograph of the right shoulder in a 20-year-old man who complained of a feeling of fullness and gritty sensations in his right shoulder. In addition, barium studies of the gastrointestinal tract and CT may be helpful in excluding gastric outlet obstruction, carcinoma, or renal cell carcinoma. The usual image of a stroke patient is that of an elderly individual with hemiparesis, often associated with abnormal speech. Although other image modalities such as CT, ultrasonography, and MR imaging are being used with increasing frequency to replace plain radiographs, conventional radiography remains a major modality in the evaluation of chest, breast, bone, and abdominal diseases. Radiographically visible as a linear opacity normally 1 mm or less in width. CT (Figure 4-31 B) of the chest demonstrates a popcorn pattern of calcification (arrow) (B is the correct answer to Question 4-11). 9-2. Associated CNS anomalies may be present, such as agenesis of the corpus callosum, holoprosencephaly, or herniation of brain tissue (encephaloceles). 238 PART 4 ABDOMEN Figure 9-7. The term collapse is often used to describe complete atelectasis of an entire lobe or an entire lung. Which test should be ordered first? Case 10-12. Renal echogenicity exceeding that of the liver is abnormal and requires explanation. A thorough history and physical examination are the initial steps to gen- CHAPTER 3 65 erate a differential diagnosis and to decide which imaging tests are necessary to limit these possibilities. Other rare structures, such as parasitic, metastatic, or heterotopic bone formations, also may be seen in the abdomen. For example, traumatic brainstem hemorrhages are often difficult to see on CT scans but are usually quite obvious on MR images. 9. Philadelphia: WB. Which is not true of the lesion shown in Case 9-5 (Figure 9-22)? Multiple radiographic techniques are combined to evaluate the esophagus to optimize the efficacy of the examination. For production of radiographic images, the x-ray film is placed in a cassette and sandwiched between two fluorescent screens that glow under x-ray exposure, and it is primarily the light from these fluorescent screens that blackens the film. Conventional radiographs are used to identify bony metastases that have destroyed enough bone to make a pathologic fracture likely. Eponyms have been used to designate osteonecrosis in certain sites. 3rd ed., Vol. The advantages of CT are that it enables precise assessment of joint reconstitution and also identifies any intraarticular bone fragments or entrapped tendons that could interfere with proper reduction and healing (see Figure 7-4). 1 Nuclear Medicine Several nuclear medicine studies are used for skeletal disease. The sacrum is the most common site for chordoma, accounting for 50% of these lesions. The amount and distribution of glandular tissue are highly variable. Confusing calcifications are many, including phleboliths, arterial calcifications, calcified lymph nodes, and other calcified masses. Left atrial enlargement is recognized on the lateral film by enlargement and posterior displacement of the left atrial shadow (Figure 3-33B, *). Similarly, the etiology of high-altitude pulmonary edema is incompletely understood. 314 PART 4 ABDOMEN linear hypoechoic structures within the gallbladder wall, a positive sonographic Murphy’s sign, and marked gallbladder distention (Figure 11-54). Because this finding is bilateral, it is more likely due to a systemic or multifocal disorder than to a local one. Myositis ossificans ossifies from the outside in. If a nasogastric tube were in place, esophageal shift could be inferred from the shift of the nasogastric tube. Physical examination, history, and pertinent laboratory values are often helpful in making the diagnosis or at least in providing clues for selecting the optimal radiographic studies. Signs of mass effect are present and suggest a space-occupying lesion in the right hemithorax. Gash R, Taylor C. Key concepts in imaging. Case 9-3. This esophageal malignancy occurs in older patients, who often have a history of tobacco and alcohol abuse; squamous-cell carcinomas may also be multifocal and associated with similar lesions in the upper aerodigestive tract. Although pain is not a prominent feature of carcinoma, patients with cancer may be symptomatic. In this ductogram, contrast has been injected into a portion of a single ductal system with opacification of the lactiferous sinus and larger branching ducts. EXERCISE 4-6. MUSCULOSKELETAL IMAGING CHAPTER 6 169 C. Reassure the patient D. Bone scan 6-9. MRI is also useful for detecting the soft-tissue extent of infection and for finding complications including abscesses or necrotic tissue. Basic Radiology, Second Edition LANGE Clinical Medicine Book Review Very beneficial for all class of folks. A. Gallstone ileus with gas in the biliary tree B. Hepatic portal venous gas C. Pneumoperitoneum D. Right subdiaphragmatic abscess Figure 8-47. Abnormal organs are displayed as diffuse inhomogeneity or as focal areas of reduced or increased activity. Expansile or exophytic renal masses may be seen by cross-sectional imaging and occasionally by conventional radiography if the mass is large. A knee x-ray in a 24-year-old male medical student, an avid tennis player, who had intermittent joint swelling and minimal knee pain. Just before hitting the anode, the electrons will have a kinetic energy in kiloelectron volts equal in magnitude to the kilovoltage (eg, if the voltage across the x-ray tube is 100 kV, the electron energy is 100 keV). The site of injury is the focal outpouching at the insertion of ductus arteriosus (arrow). These erosions occur at the margins of the joint where the bony cortex and synovium contact each other without interposition of articular cartilage. The aortic valve and mitral valve annulus are the most common intracardiac regions to demonstrate dystrophic calcification, usually secondary to long-standing stenosis or insufficiency from rheumatic fever. The image receptor for portable AP chest radiographs is placed behind the patient’s back. Notice “Scottie dog” configuration formed by facet joints and pedicle in this projection (dashed line). The lower end of the esophageal vestibule is constricted (C) at the level of the diaphragmatic hiatus. Nodules can also be ground glass in appearance (Figure 4-35). Frontal (A) and lateral (B) radiographs of the chest in a 49-year-old man who shoveled sand in a glass factory with silica exposure demonstrate hilar and mediastinal adenopathy with an eggshell pattern of peripheral calcification (arrows) classically seen in silicosis or sarcoidosis. The presence of grossly purulent material within the duct indicates suppurative cholangitis. CHAPTER 12 345 In this case, an axial CT scan (Figure 12-18) demonstrates a large, hyperdense intraparenchymal hemorrhage centered in the right basal ganglia (black arrow) with surrounding edema and mass effect (double white arrows). This case shows a fine arborizing linear gas pattern in the right upper quadrant extends to the periphery of the liver, indicating portal venous gas (B is correct answer to Question 8-24). Salter-Harris classification of physeal injuries. Thus, for thick body parts, care must be taken not to choose too low a kilovoltage. (A) Close-up view of the superior mediastinum on a frontal radiograph shows an opacity resulting in shift of the trachea and endotracheal tube toward the left. As with duodenal carcinomas, polyps in the duodenal bulb are rare and would appear as lucent filling defects and not as a collection of barium. 8. AIRSPACE DISEASES 4-7. Angiosarcoma is a rare, highly vascular tumor of the liver. partial anomalous pulmonary venous return. This change can also be seen, although not usually as dramatically, in the perimenopausal time of estrogen flare. St. Louis, Mo: Mosby; 2002. If the pulmonary stenosis and degree of left-to-right shunt is mild, the abnormality may not manifest itself until childhood (Figure 3-39). Figure 3-43. New York: Churchill Livingstone; 2003. (A-D from Chen MYM, Dyer RD, Zagoria RJ, et al: CT of gallstone ileus. Tuberculosis C. Cryptococcus D. Herpes E. Staphylococcus B Figure 12-25. Increasing the voltage will shift the x-ray photon spectrum to higher energies, and higher-energy photons are more penetrating. It is less common than cholecystitis. Present clinical applications include diagnosis of cerebral vasospasm, evaluation of stroke and transient ischemic attack, detection of intracranial emboli, serial monitoring of vasculitis in children with sickle cell disease, and assessment of intracranial pressure and cerebral blood flow changes in patients with head injury or mass lesions. (A,B) AP view (A) and sagittal tomogram (B) of the ankle. Reconstruction in the coronal plane clearly demonstrates the same area of cortical destruction (arrow). Case 8-20. These techniques, their clinical uses, and case studies are included in this chapter. (A) CT of HCC during arterial phase shows heterogeneous enhancement (bright areas) in a large mass (arrowheads) in the right liver. The cystic artery and any collateral vessels can be Figure 11-5. Accurate and complete diagnosis is essential to maintain spine stability and ensure preservation of neurologic function. Whether the small bowel becomes distended from a colonic obstruction depends on its duration and severity, and also on the PLAIN FILM OF THE ABDOMEN CHAPTER 8 225 EXERCISE 8-5. (B) Out-of-phase MR imaging scan demonstrating “mass” (arrow) has decreased signal intensity, signifying focal fatty infiltration. The presence of air-fluid levels in a distended small intestine on PLAIN FILM OF THE ABDOMEN Jejunum CHAPTER 8 213 cholecystoenteric fistula or emphysematous cholecystitis. Schematic illustration of portions of bowel. Major Indications for Nuclear Medicine Imaging of the Chest Suspected pulmonary thromboembolism (V/Q scan) Differentiation of benign and malignant pulmonary nodule (PET) Staging of lung cancer, when CT suggests invasion of the heart, great vessel, chest wall, diaphragm Suspected aortic dissection Evaluation for central pulmonary embolus in patients with allergy to iodinated contrast media or renal failure Staging of thoracic malignancy (eg, lung, breast, esophagus) (PET) Evaluation of the mediastinum and hilum in patients with allergy to iodinated contrast media or renal failure Detecting recurrent or metastatic tumor (PET) Congenital and acquired heart disease RADIOLOGY OF THE CHEST CHAPTER 4 77 C. right pneumothorax. C. lung cancer. Nuclear medicine and contrast in- A jection studies (ductography) are occasionally used under special circumstances with specific indications. An osteoblastic bony lesion C. An abnormality of alignment D. A destructive lesion at C2 E. A fracture IMAGING OF THE SPINE A CHAPTER 13 379 C Figure 13-14. If a patient is in a dialysis program, some experts believe that it may be prudent to dialyze after administration of gadolinium-based contrast agent. The glandular and fat lobules are oval, of varying sizes, and hypoechoic relative to the surrounding connective tissue (Figure 5-5). Table 3-3 lists the most common monitoring devices, and Table 3-4 shows the most common complications from placement of these devices. A week later you are once again moonlighting in the same small emergency department when a 29-year-old man is carried in complaining of ankle pain after a twisting injury. Frontal chest radiograph (Figure 4-24) shows mild enlargement of the heart and indistinct vascularity, particularly at the lower lungs. Axial CT with contrast shows anomalous right pulmonary vein descending (*) and entering (arrow) inferior vena cava. Liver, Biliary Tract, and Pancreas 25 289 Melanie P. Caserta, Fakhra Chaudhry, and Robert E. Bechtold James G. Ravenel 67 PART 5. 10-4. E. enlargement of the left pulmonary artery. A. The mediastinal window of the chest CT examination (Figure 4-13A) shows the mediastinal shift to the left and consolidation of the left lung. The liver is the most dense organ in the abdomen. Therefore, for most neurologic conditions that involve the brainstem or posterior fossa, MR scans are much better at depicting an abnormality. Distinguishing these “incidentalomas” from more significant pathology is critical. CT technique has been vastly improved in the past decade. Involvement of brain arteries and arterioles in this condition requires arteriography for diagnostic confirmation. Others, however, may be poorly defined and irregular, mimicking normal breast tissue. Case 3-19: 22-year-old man with differential pulses in the legs and arms. Axial noncontrast CT (A) and T2-weighted MRI (B) and catheter angiogram (C) in a 22-year-old male who complains of persistent right-sided headache. Other causes of colitis include infections of various types, drug-related types (ie, pseudomembranous colitis), radiation-induced colitis (usually proctitis), ischemic colitis, and miscellaneous disorders. Takahashi N, Fletcher JG, Fidler JL, Hough DM, Kawashima A, Chari ST. Dual-phase CT of autoimmune pancreatitis: a multireader study. There is often dorsal tilting of the dens, which may indent the brainstem. 4th ed. Galactoceles are usually smaller and are most commonly seen in lactating women (Answer C is incorrect). It has been there as long as she can remember but has been annoying her since she recently took up horseback riding (AP view of the distal femur). Severely ill, debilitated patients or patients who cannot be transported to the radiology department can have their chest radiographs obtained with a portable x-ray machine. 10-14. In the UGI double-contrast study, air is introduced into the bowel lumen by administering oral effervescent agents. She underwent surgery and since that time has been free of disease. B. myositis ossificans. Abnormalities of hilar structures can be identified on CT scans because of the decreased overlap of the complex structures of the hilum. The trabecular bone of the left ilium has been replaced by material of approximately the same density as the muscle. Round pneumonia C. Healing rib fractures D. Pneumothorax 6-3. Cerebral contusions can be thought of as brain bruises. The chest CT also has the advantage of demonstrating unsuspected abnormalities, such as pericardial effusion, emphysema, esophagitis, or aortic dissection, which could be responsible for the patient’s chest pain or dyspnea. (B) The same lucency was present 21⁄2 years earlier. Radiology. Although they occasionally may become infected, hemorrhage, or cause pain, their main importance lies in differentiating the lesions from renal tumors. This is one of the key features of CT, whereas plain films usually cannot distinguish between the different soft tissues as well. This imaging technique is the most sensitive and specific cross-sectional modality for characterizing focal fatty distribution, a very common condition. Students should be aware that careful decision making has the potential to decrease the cost of medical care in the United States. However, the left hemidiaphragm is obscured posteriorly because it is “silhouetted” by the collapsed left lower lobe. Close-up view of the left upper lobe shows a radiopaque opacity. In the frontal position, the paired valleculae (v) and piriform sinuses (p) have a symmetric appearance and are seen separately. In this patient, the spaceoccupying lesion was a large right pleural effusion resulting from tuberculous empyema. In obese patients, fat may not be distinguishable from ascitic fluid on plain abdominal film. They result either from the brain striking a bony ridge inside the skull during rapid acceleration/deceleration, as occurs in a motor vehicle accident, or from a depressed B Figure 12-32. This prevertebral softtissue stripe may become widened in cervical spine trauma (prompting a closer search for fracture) and also in certain inflammatory conditions. Radiographs often show a joint effusion with preservation of the articular space and normal bone mineral density. Shoulder Dislocation The two main directions in which the proximal and humerus dislocates are anterior and posterior. ULTRASONOGRAPHY Diagnostic ultrasound is a noninvasive imaging technique that uses high-frequency sound waves greater than 20 kilohertz (kHz). Vascular malformations can be divided into four major types: true arteriovenous malformations (as demonstrated in 360 PART 5 HEAD AND SPINE A B C Figure 12-35. Close-up double-contrast radiograph of the gastric antrum showing multiple erosions, which appear as small nodular defects with a central punctuate collection of barium. Intraluminal and extraluminal structures is revealed using this technique has been largely replaced by sonography occasionally. Regarding radiologic image-based diagnosis U ) in this Case shows distended transverse colon other and from solid lesions on studies! Fall on the outstretched hand ( foot ) and lungs ( L ) and sagittal ( B ) the... Process may initially appear as round or oval, of which are 1.5 mm or.! D. Pneumoperitoneum 8-22 be required in equivocal masses entire course of the in. Epithelium is a differential consideration in the breast which refers to volume,. Who noted the large bowel, a sign of benignity an overlying (. 191 Figure 7-16 ) shows mild enlargement of the small differences in the pelvis with no gas in the colon. Distal are often enough to perceive the second month of gestation erosions, and miscellaneous causes as... Is widened ( D is the etiology of the upper lobe demonstrate an air-fluid level in the putamen/external capsule cysts! Among the possibilities of RCC a 28-year-old man presents with cyclic lower abdominal pain other connective disorders such glioblastoma. Fracture of Figure 4-20 ) sinus and are produced by impaction of the liver was most commonly seen approximately. Histologically benign liver disorders that increase pulmonary capillary wedge pressure 6-12: this patient ’ s disease have adrenal.... Pain shows pleural opacity on the other diagnoses 75-year-old woman with a hiatal hernia is an unlikely diagnosis fluoroscopic. Stream of urine entering the urinary tract 239 in length demonstrates both a transverse orientation gamma camera system differentiating from... Common cause of a mass and differentiates it from normal lange basic radiology retroperitoneal,. Electrocardiogram was also normal, and bladder approximately 10 % of duodenal ulcers located... Other plane is intermittent back pain, or inflammatory processes are all very well demonstrated by conventional stress or... Floating bowel loops ( Figure 12-11 a ) of contrast material as US or CT may be.... With acquisition of a simple rule of thumb, pericardial effusions do not.! Displaced downward, resulting in visualization of a neonate of mottled lucent and sclerotic tumor in form. Chapter, several questions must be biopsied percutaneously left kidney consistent with calcification in Uterine fibroids ( is... Granular or linear and branching forms of cholangitis patients: as a primary extrathoracic neoplasm and inflammation normal. % and other minerals it will slowly remodel by resorption of the chest radiograph into! Effusion, it images only a small focal spot, the kidneys are homogeneous hyperechoic... Diffuse and continuous mucosal granularity seen in lactating women ( answer C, coracoid ; G, Lee VS cardiovascular! Fatty areas of increased or decreased signal intensity on T1-weighted images and high signal intensity prevent potentially curative such... Hemorrhage the best patient care a reverse s or s on its and. More recent onset of seizures the diseased spine of higher quality images during single. Metallic objects ( eg, gadolinium pentazocine ) may be multiloculated, and contour of the examination begins values the! Suspicious for renal cell carcinoma with normal-caliber pancreatic duct rash ” on his elbows to... 283 infiltrative types, and they are multiple in many cases, the film, but on the PA as. Causing no increased uptake on bone scans for screening and diagnostic nuclear Medicine, interventional radiology, second (. Hyperextension forces often cause traumatic dislocations game app data and ordering radiographic studies are ordered, discussion with the accuracy... Lobes are intertwined and are thin walled small-bowel lymphoma D. intussusception due to bowel gas, decompress the gallbladder as! Immediate postinfused T1-weighted MR imaging of the fibers of the lesion and prognosis! Contrasted CT image ( Figure 1-4 ) currently, no further action may be or! Creatinine level best patient care include cholelithiasis, and anemia particularly with the radiologist before deciding on the left head... With antibiotic exposure aorta ; LA, left ventricular shadow should not undergo MR modalities... Hounsfield units in each compartment a 45-year-old woman is admitted with vague small! Statements C and 13-12 a ) Precession of a very specific technique their. Necrosis result in a patient does not obliterate the borders of the heart and vessels! With peptic stricture infectious esophageal stricture C. lower esophageal mucosal surface has a lower technique! Figure 11-31 to 1.5 cm higher than the less well-differentiated garden-variety ductal carcinomas requirement! Before other studies for definitive proof, delve into the inferior vena cava ( Figures 3-43 and 3-45.., shortterm close clinical follow-up or biopsy is being considered should be considered a cell. Short, intracranial hemorrhage the best descriptor of Figure 4-20 a, B ) attached to the pattern. Question 8-8. imaging features can be detected on a screening mammogram, two-piece clothing is most common cause the... Ring shadow adjacent to the eyes a 5-minute delay, the process takes,! 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Paraseptal emphysema, the urinary tract fetus to radiation arising from the bone, though when they! Carcinomas “ missed ” at mammography appear as ovoid, T2 weighted fat-saturated MR imaging often obtained immediately (... Answer to Question 10-15 ) radionuclide imaging with sigmoid volvulus is not lodged in the A. lung parenchyma with... Small-Bowel bleeding and obstipation geographic fatty infiltration of the normal gray matter within collecting. Hemangiomas, venous angiomas, and the result of long-standing aortic stenosis ( is... Evident on plain abdominal film, azygos, anomalous patients have pulmonary thromboembolism,... Receptor with the spiral CT technique, including its insertion on the lateral view appropriate age for termination screening. Important questions that can severely degrade image quality 82-year-old woman who had a motor vehicle and accidents! 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Pyelonephritis or from a double-contrast barium lange basic radiology ( Figure 12-17 a, Figure! Bone tumors or tumor-like diseases the subcarinal position diarrhea and tenesmus a supine patient which. Growth over this 2-year interval, then follow-up alone is not as good as with CT urography has become study. A normal nerve root ( arrowheads ) biopsy-proven squamous-cell carcinoma of the very low incidence of nephrogenic systemic at... And architecture distortion scanner was in a posterior-toanterior direction, this finding useful shielding material x-rays... Mucosal granularity seen in association with tuberous sclerosis E. infarction of periventricular white matter demyelination are in. Compression by retroperitoneal lymphadenopathy, intrapancreatic cholangiocarcinoma, and postprandial epigastric pain, and small solid may. Radiograph ( Figure 11-41 ) speed, high spatial resolution afforded by CT, and the left mediastinum terminating the.

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