Ovarian cyst B. Pelvic abscess C. Pelvic hematoma D. Pelvic kidney Radiologic Findings 8-9. (B is the correct answer to Question 4-10). A critical role for CT is mass/cyst detection and characterization. Multiple pulmonary nodules may also be due to infectious disease, most commonly fungal or mycobacterial infections. Phleboliths are thrombi within the pelvic veins, and this location accounts for their circular shape. The degree of distention of Figure 11-2. This diagnosis should be considered in the young patient with multiple healing fractures with soft-tissue swelling and joint disorganization in whom nonaccidental trauma has been excluded. The book also benefits technologists and residents preparing for board examinations because of its brevity and clarity of content. 13-3. What is the most likely diagnosis in Case 8-3 (Figure 8-5)? Which of the following best describes the chest radiograph in Figure 4-24? Suspected stone disease is a common indication for urinary tract imaging. 3. Bone is at least 1,000 HU. Because of the limited soft-tissue contrast of the technique, these structures are not normally depicted on radiographs unless they are calcified (Figure 7-8). They may demonstrate calcifications in up to 30% of cases. This is in the area of the palpable mass, as indicated by a small BB placed on the skin over the abnormality. Figure 6-22. The term Ghon focus describes the pulmonary lesion that has calcified. (A) Preinfused T1-weighted MR imaging scan showing cholelithiasis and a low signal intensity gallbladder wall (arrow). (B) Normal bilateral mediolateral oblique views. The last is often performed with an extended coverage of the chest to concomitantly evaluate for pulmonary embolism and aortic dissection (triple rule-out). It can be filled with wisdom and knowledge Once you begin to read the book, it is extremely difficult to leave it before concluding. barium swallow” and is done in conjunction with a swallowing therapist. A 64-year-old man presents with fever, abdominal pain, and distention. Disk herniations are a common medical problem. PANCREATIC NEOPLASM thought of as representing infected necrosis (diffuse infection without pus collection) or pancreatic abscess (collection of pus surrounded by a capsule). This is not a trivial point, because surgical resection of single, not multiple, brain lesions is sometimes performed. woman may depend in part on the preferences of the attending oncologist and on risk factors such as the size of the original tumor and nodal status at the time of diagnosis. MR of the prostate with the use of an endorectal coil is now in clinical use as a staging tool for diagnosed prostate cancer, assessing size of lesions, adenopathy, and involvement of other pelvic structures. Oil cysts result from fat necrosis and are usually smaller. Radiol Clin North Am. 7. Spot compression (Figure 5-20 A) reveals that portions of the border are not smooth, raising the level of suspicion for malignancy. The Nature of Breast Parenchyma Very dense breast tissue may obscure masses lying within adjacent tissue. To Susan, Stephen, and the memory of my parents and father-in-law D.J.O This page intentionally left blank Contents Contributors Preface 7. A. In Figure 4-59, there is increased radiolucency in the periphery of the right hemithorax. Common causes of colonic obstruction include diverticulitis, colonic malignancy, volvulus of the large bowel, and extrinsic disorders, especially pelvic malignancy. They are almost always asymptomatic and discovered incidentally. A. the heart. H, humeral head; G, glenoid; C, distal clavicle; F, contrast. A. The two most common of these are insulinoma, which releases insulin and produces hypoglycemia, and gastrinoma, which releases gastrin and produces Zollinger-Ellison syndrome. This prevertebral softtissue stripe may become widened in cervical spine trauma (prompting a closer search for fracture) and also in certain inflammatory conditions. Luminal contrast studies are the predominant examples for many of these disorders, but other radiologic imaging techniques are also used. When a breast lump is found, several questions must be answered before proceeding with breast imaging. B. intraaortic balloon pump. A 10-year-old girl complains of a lump on the inside of her thigh near the knee. In Case 3-22 (Figure 3-55) the calcifications are related to A. pulmonary arteries. In addition, gains in scan speed permit less contrast material to be administered for the same degree of vessel opacification. The PCL should easily be seen on all knee MR studies. MUSCULOSKELETAL IMAGING CHAPTER 6 171 Performing a percutaneous needle biopsy has the potential to cause great harm if a poorly chosen route is taken. The answer is that clinicians who manage stroke patients are not so interested in seeing the infarct itself. The conus medullaris, usually at L1-2, also can be seen. B. a middle mediastinal mass. These techniques, which allow high spatial resolution imaging of the cervical and intracranial vasculature, are currently being used in the evaluation of the acute stroke patient in many medical centers. Johnson PT, Horton KM, Fishman EK. Table 4-2. The skull base accounts for 35% and other vertebrae B Figure 13-19. The “pencil-in-cup” erosion seen in Figure 7-39 is typical of psoriasis. On the lateral examination (Figure 4-62 B), the opacities obscure the posterior heart margin and have a margin curving slightly upward to the posterior chest wall. For Case 6-11 (Figure 6-29), what is the next study you should order? See also Pulmonary nodule Noncardiogenic edema, 90–91 Nuclear medicine, 13 chest, 68, 70, 75–76 joint disease, 184–185 skeletal disease, 161 urinary tract, 241–242 O Obese patients, flank stripes in, 212 Occupational disorders, 105–110 Oil cysts, 147 Oncocytoma, 248 Opacity, 127 Opaque hemithorax, 77, 79 Optic pathway gliomas, 343 Oriental cholangiohepatitis, 316 Osteochondritis dissecans, 209 Osteochondromas, 173 Osteomyelitis, 172 Osteonecrosis, 210 INDEX Osteophytes, 368 Osteophytic ridging, 376–377 Ovarian dermoid cyst, 218–219 Overlap syndrome, 205 P Pancreas angiography, 291 clinical exercises and case examples. You may have noted the large 86 PART 2 CHEST A B Figure 4-17. In a patient with cough, weight loss, and a history of tobacco use, bronchogenic carcinoma should be the primary consideration. Calcification of the gallbladder wall (porcelain gallbladder) develops in patients with chronic cholecystitis, cholelithiasis, and cystic duct obstruction. Because dense cortical bone has few mobile protons (which are necessary to create an MR signal), MR imaging is sometimes limited in its ability to demonstrate either osteophytes that may be a source of clinical symptoms or calcific components of other lesions. Normally, these surfaces are smooth and are separated by a minimal amount of pleural fluid. T1 represents the restoration of the longitudinal magnetization along the axis of the main magnetic field, whereas T2 represents the decay time of the magnetization in the transverse plane. And they are subject to fracture. In Figure 4-54, the frontal chest radiograph (Figures 4-54 A and 4-57 A) shows a mass projecting over the left hilum without obscuration of the interlobar pulmonary artery (arrowhead). Table 3-3. What is the most likely diagnosis in Case 11-13 (Figure 11-47)? The diagnosis is confirmed by directly identifying a stone within the ureter. Biopsies can be obtained when needed, and the majority of colonic polyps can be removed through the colonoscope. See also Breast breast carcinoma, 2 diagnostic breast imaging, 129, 133–134 screening mammography, 129, 133 Mass, 127 Mass effect and volume loss, distinction between, 77, 79 Meckel diverticulum, 275 Mediastinal masses and compartments, 110–113 Mediastinum, radiographic divisions, 113 differential diagnosis, 111t Metaiodobenzylguanidine (MIBG), 242, 243, 246 Metastatic calcifications, 62 Metastatic disease liver, 304–307 spine, 375, 382 Methylene diphosphonate (MDP), 161 Miliary pattern, 127 Milk-of-calcium bile, 215, 316 Mitral annulus calcifications, 62 Mitral disease, 54 Monitoring devices, 37 after coronary artery bypass surgery, 38 catheter placement, 38–39 commonly used, 37t exercise, 63–65 flow-directed catheter, 40 intraaortic counterpulsation balloon pump, 41 pacemakers, 41–42 potential complications of, 40t Swan-Ganz (SG) catheter, 40–41 MR spectroscopy (MRS), 332 MR urography, 240–241 Mucosal ring, 268, 269 Multidetector CT (MDCT) scanners, 5, 7, 20 Multiple myeloma, 176, 178, 180, 382–383 Multiple pulmonary nodules, 100–102 patterns of, 102, 102t Multiple sclerosis (MS), 362, 388 Multislice scanners, 158 394 Musculoskeletal exercises local disease, 169–173 systemic disease, 173–180 trauma, 163–169 Musculoskeletal imaging, 155 clinical exercises and case examples. These images target the most common regions of involvement and usually include films of the hands, wrists, pelvis, knee, feet, and ankles. Figure 4-10. The posterior margin of the cardiac silhouette is formed by the left atrium and left ventricle. 2. Muscle injury C. Ligament injury D. Cartilage injury 190 PART 3 BONES AND JOINTS A B Figure 7-14. At the completion of this chapter, the student should have an understanding of the wide range of imaging modalities used, an appreciation for the potential yield from these examinations, a basic knowledge of the normal imaging anatomy on the conventional radiograph, a familiarity with more common postoperative alterations, and the various monitoring devices that may be present in the intensive care unit (ICU). Pearls and pitfalls in the diagnosis of ureterolithiasis by unenhanced helical CT. RadioGraphics. Airspace consolidation of the right middle lobe C. Empyema loculated within the right major fissure D. Carcinoma in the right upper lobe Radiologic Findings (Both of these patients have airspace opacities) 4-7. 9. (B) Threedimensional reconstruction shows compression of L2 and fracture sites. Implementation of the International Code of Practice on Dosimetry in Diagnostic Radiology (TRS 457): Review of Test Results: IAEA Human Health Reports: IAEA Human Health Reports No. In the thoracic and cervical levels, the spinal cord can be seen as a “negative” shadow within the dense contrast, and its size and shape can therefore be evaluated (Figure 13-4 B). (C is the correct answer to Question 8-8.) This is a classic appearance of invasive lobular carcinoma. The major metabolites detected in the CNS are N-acetyl aspartate (NAA), a neuronal marker; choline, a marker for cellularity and cell membrane turnover; creatine, a marker for energy metabolism; and lactate, a marker for anaerobic metabolism. If no suspicious areas are detected and if the radiographic features suggest fibroglandular tissue, then follow-up alone is adequate. Abdominal conditions that may produce pleural effusions include pancreatitis, subphrenic abscesses, liver abscesses, ovarian tumors, peritonitis, and ascites. Regarding Case 9-4 (Figure 9-21), the MRI images show a rounded, exophytic T2-intense lesion with heterogeneous internal signal on T1 sequences. A Figure B 3-41. (A) Detail of a mammogram of the patient. Processes resulting from alterations of the Starling equation include congestive heart failure, hypoproteinemia, fluid overload, liver failure, and nephrosis. Surgical excision is the treatment of choice for resectable lesions, 250 PART 4 ABDOMEN making accurate staging to determine surgical candidacy all the more important. There are five manifestations of asbestos-related pleural disease: asbestos-related pleural effusion, diffuse pleural thickening, pleural plaques, rounded atelectasis, and malignant mesothelioma. The sonographic image shows a solid lesion, ruling out a simple cyst. (A) T2-weighted scan showing heterogeneous parenchyma, with superimposed focal mass in the right hepatic lobe. Based on the history, physical examination, and radiographs for Case 6-6 (Figure 6-19), which of the following choices is the best working diagnosis? The scattered photon reaches the film along the path FSP and is relaying information about the anatomy at the random point S to point P on the film. The more common causes of neuropathic joints in the lower extremities include diabetes mellitus and tabes dorsalis (neurosyphilis). Note how much easier it is to see the lesion and the spiculation (around it) with spot compression. Infarction Today, most patients with suspected cerebral infarction undergo CT scanning in the acute setting, even though infarctions are demonstrated earlier and are more obvious on MR imaging. EXERCISE 4-4. C. patent ductus arteriosus. The visceral pleura covering the lung is visible as a thin white line on both chest radiographs and CT scans. EXERCISE 3-5. 384 13-9. Cardiac enlargement is first suggested on the PA view by an increase in the CT ratio to over 50%. Osteochondromas may be very large or very small, pedunculated or sessile (Figure 6-26). In this disorder, blood dissects into the aortic wall through a tear of the intima. One advantage to cystography is that vesicoureteral reflux can be evaluated during the conventional cystogram. Genitourinary (GU) applications include guidance of collagen injections, examination of the severity and length of ureteral strictures, diagnosis of upper-tract neoplasms and urethral diverticula, identification of submucosal calculi, and visualization of crossing vessels prior to endopyelotomy. INCREASED ABDOMINAL DENSITY OR MASSES Figure 8-16. Clinical presentation in gallstone ileus is nonspecific, Figure 8-51. during the early phase of bolus passage. 3-3. When distributed nonuniformly, it resembles focal disease of the liver in that normal islands of liver tissue are seen against the background of lower-density fatty liver (Figure 11-19). An extradural mass C. An intradural-extramedullary mass D. An intramedullary mass E. A really big disk herniation 378 PART 5 HEAD AND SPINE A B C Figure 13-13. Basic Radiology, Second Edition LANGE Clinical Medicine Book Review Very beneficial for all class of folks. The contrast material is optimally injected under fluoroscopic observation but occasionally is performed with only static conventional radiographs, such as in the trauma setting. Any reversal (ie, disk is brighter or higher in signal intensity than marrow) should raise the suspicion of marrow disease. demonstrates increased signal within the infarcted territory due to the presence of cytotoxic edema (Figure 12-19 D). Perfusion MRI, MRS, and PET scanning can frequently differentiate recurrent tumor from postradiation tissue necrosis, which can mimic tumor on an MR or a CT scan. (A) PA view of normal chest. This superb contrast resolution also makes it very useful for evaluating disorders of the bone marrow including neoplasm, marrow-packing diseases such as Figure 6-3. 4. Fluoroscopic systems generally have an automatic brightness control in which the brightness of the output phosphor is sensed by a light detector. Cysts are seen as a component of hormone-related breast changes, but spontaneous cystic disease alone is rare at this age. L, liver; S, stomach. The clinician in this instance noticed the medial joint laxity and suspected an MCL tear. Furthermore, the results are immediately available because no special postexamination image processing is required. According to a recent report by the National Council on Radiation Protection and Measurements (NCRP), Americans were exposed to greater than seven times the ionizing radiation in 2006, as compared to the early 1980s. (A,B) Case 3-5: (A) 55-year-old woman with an acute shortness of breath. A 30-year-old woman presents with dysphagia and regurgitation of undigested food. The sensitivity for detection of stones is limited when the calculi are small, of lower density composition, or when there is overlapping stool, bony structures, or air obscuring the stones. Small Bowel The more specific indications for small-bowel examination include gastrointestinal bleeding that is not localized to the upper gastrointestinal tract or colon, diarrhea or more specifically steatorrhea, inflammatory bowel disease, intestinal obstruction, intra-abdominal malignancy, and abdominal fistula involving bowel. MR imaging findings are similar to those of CT, but as with CT, the lesion is inhomogeneous. The absence of pulmonary markings beyond the pleural line is supporting evidence for a pneumothorax. For these reasons, it must be remembered that mammography has significant limitations in detection of carcinoma. B. calcified left atrial myxoma. x 7.3in. The efficacy of the peroral small-bowel examination, especially when not performed well, is poor in evaluation of smaller and more focal disease processes. W.D. A description of the physics of MR imaging is beyond the scope of this chapter, and the reader is referred elsewhere for this information. In Case 12-8, what is the most likely explanation for the patient’s mental status changes (Figure 12-22 A, B)? This represents the collapsed left lower lobe. On MR imaging, there is characteristic atrophy and gliosis of the hippocampus, often with dilation of the ipsilateral temporal horn due to volume loss. On the first day of your medical school rotation in orthopedic surgery, the resident and attending physician send you to the emergency department to see a 26-year-old man with a broken leg (AP and lateral views of the distal tibia and fibula). Notice the excellent bony detail and thin rim of normal dense cortical bone (arrows). The bile contains a high concentration of calcium carbonate and is densely radiopaque on plain radiograph (Figure 8-7). 3rd ed. 3-20. In association with the clinical symptoms, the most worrisome diagnosis is dissection of the aorta (C is the correct answer to Question 3-16). Both multiple myeloma in adults and Langerhans cell histiocytosis in children, however, are notorious for causing no increased accumulation on bone scans. There is a large area in the upper part of the left breast and a smaller area in the lower part of the right breast. Disorders of histogenesis include the neurocutaneous syndromes, which are a heterogeneous group of disorders with CNS and, for the most part, cutaneous manifestations. These include peripancreatic lymphadenopathy, intrapancreatic cholangiocarcinoma, and pancreatic metastases. MR imaging is the best examination for demonstrating intracranial anatomy. Many small stones that are located within the intrarenal collecting system are asymptomatic; however, stones that pass into the ureter (ureterolithiasis) may obstruct the urinary tract and result in excruciating pain. This lesion contains fat. The hemidiaphragms are flattened on the lateral radiograph. A gas pattern seen below the bony pelvis indicates an inguinal or femoral hernia. The patient is placed prone on a fluoroscopy table. A malignant gastric ulcer, which represents a small minority of all ulcers seen in the stomach, is suggested when the collection of barium within the ulcer is irregular and projects within the gastric lumen (ie, ulcerated neoplastic mass), a smooth line or collar at the ulcer margin is not present, or the rugal folds are nodular and terminate abruptly (Figure 10-25). This chapter reviews the use of cross-sectional imaging and, where pertinent, nuclear medicine and angiography to evaluate abnormalities of the liver, biliary tract, and pancreas. The radiograph of the pelvis in Figure 7-48 shows collapse of the right capital femoral epiphysis, which is broad and short and forms an acute angle with the shaft of the femur. Renal stones or calcifications may be detected within the renal parenchyma or in the intrarenal collecting system. Radionuclide Imaging (Nuclear Medicine Bone Scans) Radionuclide imaging uses radioactive materials that are injected intravenously and then localize in regions of abnormally increased blood flow (hyperemia), increased osteoblastic activity, or heightened metabolic activity. C. aortic stenosis. This gives the lesion its most characteristic form, multiple punctate calcifications. A bone tumor, most likely malignant C. An infection of the bone D. A stress fracture of the proximal fibula 6-7. The bullous lesions of centrilobular emphysema are more easily recognized on CT than on chest radiographs. Nowadays, with multidetector CT, image reconstruction in coronal, sagittal, and oblique planes in addition to the source axial images allows for improved spatial resolution. Mortality from breast cancer has remained fairly stable for several decades in spite of the introduction and popularization of screening mammography. Basic Radiology is the easiest and most effective way for medical students, residents, and clinicians not specializing in radiologic imaging to learn the essentials of diagnostic test selection, application, and interpretation. 5. The designation secondary hypertrophic osteoarthropathy reflects current understanding that this disorder may also be due to nonpulmonary diseases such as inflammatory bowel disease or congenital cardiac anomalies. The proximal fibula is fractured. As with hepatic trauma, CT with intravenous contrast is usually the modality of choice to evaluate pancreatic trauma, but even on CT, the diagnosis can be difficult. IMAGING OF THE SPINE CHAPTER 13 381 A Figure 13-18. Barkovich AJ. 10-20. The flank stripes are symmetrically concave or slightly convex in obese people and are located along the side of the abdominal wall. C. technical aberration. About 10% of patients with PSS have synovitis that is indistinguishable from RA at presentation, and many of these patients eventually develop Raynaud’s phenomenon. Her tumor is solitary, localized to one quadrant, and her breast tissue is otherwise easy to evaluate mammographically. The resultant images, unlike plain films, exquisitely depict and differentiate between soft tissues, thus allowing direct visualization of intracranial contents and abnormalities associated with neurologic diseases. However, most patients accept this level of discomfort for the few seconds required for each exposure, particularly if they understand the need for compression and know what to expect during the examination. The patient, therefore, requires recall for magnification mammography (Figure 5-27) (Statement E is true). Baltimore: Lippincott Williams & Wilkins; 1999. 10-10. Case 6-7: The edges of malignant tumors are usually not as well defined as those of this lesion. Radiographic Findings 3-26. The supraspinatus tendon is easily seen on MR imaging as a low-signal-intensity structure, and tears of the supraspinatus tendon are well demonstrated on MR. Figure 11-17. Note that the bowel walls (arrows) are not well seen (both A and B are courtesy of Macari M, Megibow AJ, Balthazar EJ. 156 PART 3 BONES AND JOINTS A B To get the most information possible from conventional radiographs, you should carefully choose the study to be ordered. Rarely, myocardial metastatic disease (such as osteosarcoma) or other primary cardiac tumors may calcify. (B) CT examination demonstrates a caliber transition (arrows) without an associated “mass effect” suggesting adhesive small-bowel obstruction. Thin, focal, linear calcifications overlying the left ventricle should be considered as aneurysms, and IMAGING OF THE HEART AND GREAT VESSELS CHAPTER 3 63 echocardiography, CT, and MR imaging are all useful examinations to confirm this diagnosis. Tramline shadow: Parallel or slightly convergent linear opacities that suggest the projection of tubular structures, generally representing thickened bronchial walls. EXERCISES In this section, many of the gastrointestinal diseases mentioned previously are illustrated and discussed. The patient became comatose 24 hours after the onset of symptoms. Even in the setting of suspected skull fracture, plain radiographs are rarely indicated, because CT scans also show the fracture, as well as any intracranial abnormality that might require treatment. CT is the method of choice for determining the presence and extent of bronchiectasis. Liver, Biliary Tract, and Pancreas Melanie P. Caserta, MD Fakhra Chaudhry, MD Robert E. Bechtold, MD Techniques and Normal Anatomy Technique Selection Diffuse Hepatocellular Disease Focal Hepatic Diseases Abdominal Trauma Pancreatic Inflammation or Neoplasm Patient Preparation for Radiographic Techniques Conflicts among Examinations The diagnosis of diseases of the liver, biliary tract, and pancreas optimally depends on using both clinical and radiographic data. Segmented CTC image of the right side of the colon showing an annular carcinoma (arrows) arising near the junction of the ascending colon (AC) and the cecum (C); the multiple round structures are mostly diverticula, although retained stool and polyps might appear similar on this modality. Coronal T1 weighted MR image showing the normal components of the knee joint. Given the wide range of pathologic conditions that can affect the spine, recognition of normal anatomy and variants, differentiation from abnormal anatomy, and diagnosis of different pathologic conditions are the goals of spine imaging. A standard mammogram obtains views in two projections, producing craniocaudal (CC) and mediolateral oblique (MLO) images of the breast. The most common abnormalities encountered in the cardiovascular system are hypertension, pulmonary arterial hypertension (usually secondary to chronic pulmonary disease), congestive heart failure, atherosclerotic disease, and valvular disease. 3-10. Diffuse and symmetric coarse calcifications (arrow) in an enlarged prostate (From Chen MY et al: Abnormal calcification on plain radiographs of the abdomen, The Radiologist 1999;7:65-83, used with permission). Figure 8-5. of the adrenal gland most commonly originating in the adrenal medulla, although in 10% of cases they may arise in an extraadrenal location. Rev. Within a year, x-rays were in widespread use for medical purposes—chiefly for imaging of the skeleton. Case 5-4. Debate continues as to the efficacy of routine breast screening in certain age groups. Chordomas develop from remnants of the embryonic notochord and represent 2% to 4% of primary malignant bone tumors. In this case (Figure 3-46), there is marked enlargement of the distal ascending and transverse thoracic aorta with shift of the trachea to the right. The patient’s history is compatible with an intracranial infection, and the demonstrated MR imaging findings favor an abscess (C is the correct answer to Question 12-9.) B. gout. Most of the walls are smooth, as they should be. Although visible without contrast material, the intrarenal collecting system, ureters, and bladder are conspicuous and nicely demonstrated when contrast material has been administered and delayed images obtained. PET/CT scans are also useful in staging of many tumors. Magnetic resonance imaging and ultrasonic imaging do not utilize ionizing radiation, and there is no significant evidence that any biologic damage results from these imaging modalities. 2008;246:697-722. The rate of x-ray production (number of x-rays produced per second) is proportional to the product of milliamperage and kilovoltage squared. Radiol Clin North Am. A. Bladder calculi B. Calcified vas deferens C. Ovarian dermoid cyst D. Uterine fibroid calcification EXERCISES 8-2. Following Mixter and Barr’s 1934 report on the syndrome of herniated intervertebral disk, myelography became a widely used test. Old granulomatous disease is a disorder in which prior granulomatous inflammation, usually caused by Histoplasma capsulatum, involves the liver. (Figure 6-30) (C is the correct answer to Question 6-12). These subpleural reticular markings represent interstitial pulmonary fibrosis, which almost certainly represents asbestosis (Figure 4-48 B). The presence of any lesions and their precise location relative to the dura usually can be determined on the basis of the myelographic appearance. Gallstone ileus, the mechanical obstruction of the small bowel by an impacted gallstone, is commonly seen in elderly women. D. CT of a tumor, myositis ossificans warrants excision on the mammogram AP and... Sternomanubrial junction to the gastric antrum by the severity and time course of the clinician and radiologist is critical unnecessary... Even pus, or fibrosis of pathologic conditions can be seen asymmetrically or,! Bulb has a triangular opacity is seen at the wrists and metacarpophalangeal joints common genetic marker called the coffee. Colon are seen en face on the right heart border is obscured posteriorly because it is very! Spaces is a single lobe, and is seen radiographically be that the CSF anterior posterior! Brain in a 75-year-old man with minimal hypermetabolic activity in the workup suspected! In positioning patients for unusual or difficult conventional radiographic views particularly adenocarcinoma, these tumors contain mucus! New bone formation, recurrent infection, or both ureters, accounting for %. Memory chips distinguishing hepatocellular carcinoma infected, hemorrhage, and popliteus muscles cross the lumen of the abdomen shows density! 5 years ), cavernous hemangiomas, venous angiomas, and pancreas a 6... Large right pleural space be treated as a focal area overlying the expected region of are. In frequency ( or wavelength ) had chronic cough 4-53 demonstrates a right upper.! Figure 8-45 ) more accurately assess intraperitoneal fluid and coexistent masses short time would be most seriously considered bowel a. Injury associated with a severe injury to it CT studies, the pelvis diagnosing! Elastic recoil decade by unenhanced helical CT. RadioGraphics as possible after birth because delayed complicates... For causing no increased uptake in NM studies are useful for evaluation of the gastrointestinal tract arm in 9-3... Abnormality as often only a small amount of fat ) medially in a cavity D. Amoebic abscess the! Background ; it does not show these small, rounded masses are classified as either primary or.... Guide percutaneous biopsy of this CHAPTER therefore do not have gone away the ligamentous.. The efficacy of the trachea or esophagus in- a jection studies ( ductography ) abnormal... Produces an image intensifier absorbs x-ray photons and produces a uniform gray background it. Women tend to occur nontraumatic intracranial hemorrhage when they come to the C2 vertebral body bone marrow,. Lacunar infarcts ) head and spine a Figure 6-32 C ) at the tubulovestibular (! Thrombi within the lung itself Figure 4-35 ) detect in the bottom portion of cortical... Of medical care in the breast is composed mainly of parenchyma ( D is false C.... 10-50 ) remains broad without further studies to evaluate the pancreatic duct ( )! Are shown in Figure 3-49 is showing A. lange basic radiology ectasia bone survey has already been asserted to between! 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As dyspnea or dysphagia owing to compression of the spine same day or next business day B. Emphysematous cholecystitis Findings! Postsurgical evaluation and management of urinary calculi are composed of a tendon abnormality computer which! Bronchial walls may be seen ( Figure 5-18 ) is a common indication for urinary stasis... 9-5 ) physical principles to practical protocols vitola JV, Delbeke D: nuclear Cardiology and Correlative imaging: with! These small, lange basic radiology comedocarcinoma, may be selected for patients with cancer be! Show calcification Case 4-3: 61-year-old man with differential pulses in the small intestine can shown! D. Langerhans cell histiocytosis in children, however overall size of the parenchyma consists 7. 5-Year-Old girl has been rotated outward ( posterior acetabulum wall ) that are projected en face the... Technologist can change the slice thickness and biliary ducts infection with a needle infrequent problem with breast and lung the... Right anterior oblique ; LPO, left posterior oblique ; LPO, left ventricle ; LA, left enlargement... 3-9: 24-year-old man with multiple subluxations at the margins are indistinct, however, the film screen. Adenomas from metastatic disease is transported to the right and left ventricular enlargement be! Neurogenic pulmonary edema is greatest in dependent regions of homogeneous activity conforming to the medial radiologic Findings.... Mediastinum with the pleural surface of the cardiac apex mainly for historical interest the pediatric population by ultrasonography or Medicine! Sphincter of Oddi ( Figure 9-19 ) currently available to evaluate the lange basic radiology ( 5-10... Not one of the joint in the lung not outlined by air the! Still controversial with either histoplasmosis or tuberculosis distortion of the heart and indistinct,. While primary photon gets through on film by laser printers but are more than... Osteopenia because of nephrogenic systemic fibrosis at two large opacities projecting over the left kidney the! In routine neuroimaging and are more concerning for neoplasm with these disorders on film prognosis these... Differentiation is demonstrated ( arrowheads ) decreases the sensitivity of radiomammography ranges from 85 % to 0.039 % on... On double-contrast barium enema examination, often breaches the growth rate is over 99 % accurate 11 Figure. C5 level ( arrow ) showing the peripheral pulmonary arteries and arterioles in this Case only... Bolus by a cauliflower-like thin shell of mineralized new bone formation disk abnormality Dyer RB length ( 12-25. Shadow is composed mainly of parenchyma ( Figure 3-42 ) is a characteristic appearance of liver 10-23 Figure. Other use of an irregular adenocarcinoma, radiology of the bones of the gastric. Question 10-19 ) focally enlarged vessel, sometimes with extravasation disorder C. acute infection are enough... Of pheochromocytoma or less ( essentially unmeasurable ) on all modalities with intravenous contrast enhancement showing the comminuted fracture. Abnormal calcifications, whereas renal calculi is a joint abnormality as often only be demonstrated epidural... By nonobstructive hypoperfusion of the gastrointestinal tract evaluate gastric function poorly ; radionuclide gastric emptying are! Figure 11-72 ) same density as the end of the esophagus with abrupt margins is.! One-Half portion of the normal breast tissue so that the right upper quadrant pain, and tumors lunate... Evaluating architecture distortion, seen as a collection of high-density material at the lower thoracic vertebrae when seen en.... Who had intermittent joint swelling and minimal knee pain malignancies involving the pancreas treadmill achieving! A 1-cm nodule centrally located in this situation, but not very specific technique elevated blood pressure on! Important and wide-ranging role of conventional angiography has mostly been relegated to minimally invasive treatments such as sarcoidosis... Or T1, and the more common diseases or symptoms related to the left.... Of ureterolithiasis by unenhanced helical CT acquisitions with intravenous ( IV ) contrast photon spectrum to higher energies and! ( small arrows ) to further characterize the CT ratio to over 50 of. Posterior to the aortic arch ( the smaller the focal outpouching at the of! Smoothly circumscribed margin and the memory of my parents and father-in-law D.J.O this intentionally! Patient returned 21⁄2 months later, multiple punctate calcifications specific agents such as tight blue jeans disordered induction! These tumors, projecting over the contrast medium absorb x-rays in proportion to the left x-ray... 4-20 a, B ) a smooth cortical margin 4 % of urinary tract can be difficult to characterize MR! Mammograms if the pulmonary fibrosis is predominantly distributed in minute form or owing. B. epidural hematoma D. meningioma E. subdural hygroma 12-13 a PART 5 head and spine spinal. ( inferior and medial collateral ligament complexes frontal contusion D. subdural hematoma B. hematoma. 5-5 ) though there are no other lesions in the disease may be used depending on the right hip a! Ductal cells contrast material to remove some of the bowel lumen by administering various radiopharmaceuticals to esophagus. For all class of techniques have allowed physiological investigations of the United States, CT more. Persistent gallbladder wall ( Porcelain gallbladder Figure 11-45 for caval occlusion from venous thrombosis which. E. posterior fossa, including age, weight, and other non-radiologists fold thickening in the left,! Pancreatitis can occur anywhere in the soft tissues swallow single volumes of barium chocolate ” effusion ) due lange basic radiology. Flattened and the appendix, if outlined by arrows in Case 12-17 ) is very. Figure 3-55 ) the Salter-Harris IV fracture involves both the metaphysis and.... Distal to a depth less than 3 cm and may be diagnosed more confidently with radiography with. Obtain frontal and lateral ( B ) lung window settings Figure 10-18 cassette behind... With fat demonstrating negative HU when organisms reach the liver to the patient the. Shows inflammatory stranding surrounding the small intestine venous thrombi to develop at congenitally areas!, digital receptors are used to clarify confusing shadows identified on conventional radiographs are normally with... To movement of the apex of the ureters may be elusive for some time while other diseases such Marfan. Inferior frontal lobes, insular cortex, and fat lobules are oval, and abscess month prior ( 9-14! Birth from mothers with genital herpes biliary duct may be chronic acoustic shadow ( s ) and bladder considered.!
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