Diagnostic Radiology: Chest and Cardiovascular Imaging PDF
Preview Diagnostic Radiology: Chest and Cardiovascular Imaging
DIAGNOSTIC RADIOLOGY CHEST AND CARDIOVASCULAR IMAGING AIIMS–MAMC–PGI IMAGING COURSE SERIES Manorama Berry Sudha Suri Veena Chowdhury PAST EDITORS Sima Mukhopadhyay Sushma Vashisht DIAGNOSTIC RADIOLOGY CHEST AND CARDIOVASCULAR IMAGING THIRD EDITION EDITORS Veena Chowdhury MD Director-Professor and Head Department of Radiodiagnosis Maulana Azad Medical College New Delhi, India Arun Kumar Gupta MD MNAMS Professor and Head Department of Radiodiagnosis All India Institute of Medical Sciences New Delhi, India Niranjan Khandelwal MD Dip. NBE FICR Professor and Head Department of Radiodiagnosis Postgraduate Institute of Medical Education and Research Chandigarh, India ASSOCIATE EDITORS Sanjiv Sharma MD Anjali Prakash DMRD DNB MNAMS Professor and Head Professor Department of Cardiac Radiology Department of Radiodiagnosis CN Center Maulana Azad Medical College All India Institute of Medical Sciences New Delhi, India New Delhi, India ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD. New Delhi • St Louis (USA) • Panama City (Panama) • Ahmedabad • Bengaluru • Chennai Hyderabad • Kochi • Kolkata • Lucknow • Mumbai • Nagpur Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd Corporate Office 4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India, Phone: +91-11-43574357, Fax: +91-11-43574314 Registered Office B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi - 110 002, India Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021 +91-11-23245672, Rel: +91-11-32558559, Fax: +91-11-23276490, +91-11-23245683 e-mail: Contributors Akshay Kumar Saxena MD Deep Narayan Srivastava MD MNAMS Associate Professor Professor Department of Radiodiagnosis Department of Radiodiagnosis Postgraduate Institute of Medical Education All India Institute of Medical Sciences and Research, Chandigarh, India New Delhi, India Anupam Lal MD Gurpreet Singh Gulati MD Associate Professor Associate Professor Department of Radiodiagnosis Cardiovascular and Interventional Radiology Postgraduate Institute of Medical Education Cardiothoracic Center and Research, Chandigarh, India All India Institute of Medical Sciences New Delhi, India Anjali Prakash DMRD DNB MNAMS Professor Jyoti Kumar MD DNB MNAMS Department of Radiodiagnosis Assistant Professor Maulana Azad Medical College Maulana Azad Medical College New Delhi, India New Delhi, India Anju Garg MD Kushaljit Singh Sodhi MD Professor Assistant Professor Department of Radiodiagnosis Department of Radiodiagnosis Maulana Azad Medical College Postgraduate Institute of Medical Education and Research, New Delhi, India Chandigarh, India Arun Kumar Gupta MD MNAMS Madhavi Chawla MBBS DNB (Nuclear Medicine) Professor and Head Senior Research Associate Department of Radiodiagnosis Department of Nuclear Medicine All India Institute of Medical Sciences All India Institute of Medical Sciences New Delhi, India New Delhi, India Ashu Seith Bhalla MD Mahesh Prakash MD Associate Professor Assistant Professor Department of Radiodiagnosis Department of Radiodiagnosis All India Institute of Medical Sciences Postgraduate Institute of Medical Education New Delhi, India and Research, Chandigarh, India Atin Kumar MD MNAMS DNB Mandeep K Garg MD FRCR Assistant Professor Assistant Professor Department of Radiodiagnosis Department of Radiodiagnosis Trauma Centre Postgraduate Institute of Medical Education All India Institute of Medical Sciences and Research, Chandigarh, India New Delhi, India Mandeep Kang MD Chetan Patel MBBS DRM DNB (Nuclear Medicine) Associate Professor Associate Professor Department of Radiodiagnosis Department of Nuclear Medicine Postgraduate Institute of Medical Education All India Institute of Medical Sciences and Research, Chandigarh New Delhi, India India vi Diagnostic Radiology: Chest and Cardiovascular Imaging Manavjit Sandhu MD Sanjay Thulkar MD Professor Associate Professor Department of Radiodiagnosis Department of Radiodiagnosis (IRCH) Postgraduate Institute of Medical Education All India Institute of Medical Sciences and Research, Chandigarh, India New Delhi, India Niranjan Khandelwal MD Dip. NBE FICR Sapna Singh MD DNB MNAMS Professor and Head Assistant Professor Department of Radiodiagnosis Department of Radiodiagnosis Postgraduate Institute of Medical Education Maulana Azad Medical College and Research, Chandigarh, India New Delhi, India Naveen Kalra MD Sanjiv Sharma MD Associate Professor Professor and Head Department of Cardiac Radiology Department of Radiodiagnosis All India Institute of Medical Sciences Postgraduate Institute of Medical Education New Delhi, India and Research, Chandigarh, India Shivanand Gamanagatti MD Priya Jagia MD Assistant Professor Assistant Professor Department of Radiodiagnosis Department of Cardiac Radiology Trauma Centre All India Institute of Medical Sciences All India Institute of Medical Sciences New Delhi, India New Delhi, India Raju Sharma MD MNAMS Smriti Hari MD Additional Professor Assistant Professor Department of Radiodiagnosis Department of Radiodiagnosis All India Institute of Medical Sciences All India Institute of Medical Sciences New Delhi, India New Delhi, India Rashmi Dixit MD Sumedha Pawa MD Professor Professor Department of Radiodiagnosis Department of Radiodiagnosis Maulana Azad Medical College Maulana Azad Medical College New Delhi, India New Delhi, India Sameer Vyas MD Veena Chowdhury MD Senior Research Associate Director Professor and Head Department of Radiodiagnosis Department of Radiodiagnosis Postgraduate Institute of Medical Education Maulana Azad Medical College and Research, Chandigarh, India New Delhi, India Sanjay Sharma MD FRCR DNB Vivek Gupta MD Associate Professor Assistant Professor Department of Radiodiagnosis Department of Radiodiagnosis All India Institute of Medical Sciences Postgraduate Institute of Medical Education New Delhi, India and Research, Chandigarh, India PrefaCe to the third edition The first edition of Diagnostic Radiology on ‘Chest and Cardiovascular Imaging’ was published in 1996. Rapid advances in the field of imaging necessitated revision and the second edition was published in 2003. Chest Imaging continues to be one of the most important and well-established subspecialities of Radiology. Imaging of the lungs and mediastinum requires an understanding of both plain radiography as well as Computed Topography (CT) and other imaging modalities. The phenomenal technical advances in the last few years have changed the practice of chest as well as cardiovascular imaging while retaining the importance of conventional imaging. Cardiovascular imaging has transitioned nearly completely in the past two decades from dependence on X-ray angiography for definite diagnosis to noninvasive cross-sectional imaging techniques. The roles of MRI and MDCT are under rapid evolution. Continuing education is therefore essential so that multimodality imaging approach provides best patient care in a cost-effective manner. We hope that this third edition will serve as a comprehensive updated reference book for postgraduates, practising radiologists, and chest physicians. We wish to take this opportunity to thank our faculty from Maulana Azad Medial College, All India Institute of Medical Sciences and Postgraduate Institute of Medical Education and Research for their active contribution and support without which this endeavor would not have been possible. We would also like to thank Shri Jitendar P Vij (Chairman and Managing Director), Mr Tarun Duneja (Director- Publishing) and Ms Samina Khan of M/s Jaypee Brothers Medical Publishers (P) Ltd, for their professional help and cooperation in publishing this book in present form. Veena Chowdhury Arun Kumar Gupta Niranjan Khandelwal Sanjiv Sharma Anjali Prakash PrefaCe to the first edition It is with great pleasure the faculty of Department of Radiodiagnosis at All India Institute of Medical Sciences, Maulana Azad Medical College, New Delhi, and Postgraduate Institute of Medical Education and Research, Chandigarh present the second book in the series on Diagnostic Radiology. This book is devoted to Emergency and Chest Radiology and has been written to provide the radiologist in training, in practice or teaching, physician and surgeon, an integrated review of the role of various imaging modalities and roentgen features seen in diseases of the chest and in acute emergency situations, both medical and surgical, including trauma. The plain chest radiograph remains the initial imaging modality for various chest diseases and its interpretation continues to be a great challenge. Importance of chest radiograph in the diagnosis of various diseases has been dealt with in depth in all the chapters. Technique of CT and its recent advances in the evaluation of chest diseases and potential of MRI for evaluation of thoracic lesions are covered in separate chapters. Detailed discussion on the clinicopathological aspects and radiology in common thoracic diseases like tuberculosis, nontubercular infections and malignancy, role of HRCT in specific conditions and infections in immunocompromised hosts are included. All the chapters provide information about the recent developments in various fields. Importance of having diagnostic technical facilities and role of a radiologist in handling the patient in acute emergency are highlighted. The increasing use of US and CT as an initial examination in the assessment of acute abdominal conditions has tended to diminish awareness of the value of plain radiography. The role of plain radiograph, US and CT in nontraumatic acute abdomen are covered in separate chapters. Trauma is one of the leading cause of morbidity and mortality. The incidence and severity have sharply increased during the past few decades, primarily because of the increased use of high speed travel. A disciplined approach to the assessment of trauma provides confident interpretation and avoids errors of misdiagnosis. Computed tomography has revolutionized evaluation of a patient with head injury and it remains the first modality of choice. The diagnostic evaluation of patient with craniofacial injury remains problematic because of anatomic complexity of this region, wide spectrum of fracture types, and diversity of soft tissue complication. The proper approach to radiographic diagnosis of appendicular trauma begins by obtaining the appropriate radiographs of each site. Awareness of the common, the often missed and the probable associated injuries improve interpretation and make assessment of radiographs much easier. The role of the radiologist in the management of abdominal trauma has expanded considerably in the recent years. Earlier urography, scintigraphy and angiography played an important role in trauma care. The modalities of CT and interventional radiology have improved the assessment of an injured patient and facilitated nonoperative therapy for some injuries. The proliferation of imaging modalities has increased the possibility of performing inappropriate and unnecessary investigations. The comprehensive discussion on the indications and importance of various imaging techniques in the practice of emergency and chest radiology, a systematic approach for imaging a patient with trauma affecting different organ system are covered in this book. We hope that the reader may find this book both instructive and informative for the improved use of radiological resources which in turn will serve the common goal of good health care for the benefit of patients everywhere. We wish to take this opportunity to thank our faculty colleagues from AIIMS, MAMC, and PGI for their active support, cooperation and timely submission of the manuscripts. We owe immense gratitude to Prof K Subbarao and Prof Ratni B Gujral who have been kind enough to submit their contributions well in time. Manorama Berry Sima Mukhopadhyay Sudha Suri
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