Any screen. Any time. Anywhere. Activate the eBook version of this title at no additional charge. Elsevier eBooks for Practicing Clinicians gives you the power to browse and search content, view enhanced images, highlight and take notes—both online and offline. Unlock your eBook today. 1. Visit expertconsult.inkling.com/redeem 2. Scratch box below to reveal your code 3. Type code into “Enter Code” box 4. Click “Redeem” 5. Log in or Sign up 6. Go to “My Library” It’s that easy! Place Peel Off Sticker Here For technical assistance: email [email protected] call 1-800-401-9962 (inside the US) call +1-314-447-8300 (outside the US) Use of the current edition of the electronic version of this book (eBook) is subject to the terms of the nontransferable, limited license granted on expertconsult.inkling.com. Access to the eBook is limited to the first individual who redeems the PIN, located on the inside cover of this book, at expertconsult.inkling.com and may not be transferred to another party by resale, lending, or other means. 2020_PC Abdominal Imaging The Core Requisites Joseph R. Grajo, MD Chief of Abdominal Imaging Vice Chair for Research Associate Residency Program Director Abdominal Imaging Fellowship Director Department of Radiology University of Florida College of Medicine Gainesville, Florida United States Dushyant V. Sahani, MD Associate Professor of Radiology Department of Radiology Massachusetts General Hospital Boston, Massachusetts United States Anthony E. Samir, MD, MPH Associate Director, Ultrasound Radiology Massachusetts General Hospital Boston, Massachusetts United States Elsevier 1600 John F. Kennedy Blvd. Ste 1600 Philadelphia, PA 19103-2899 ABDOMINAL IMAGING: THE CORE REQUISITES ISBN: 978-0-323-68061-5 Copyright © 2022 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid ad- vances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress Control Number: 2021932208 Content Strategist: Kayla Wolfe Content Development Specialist: Erika Ninsin Publishing Services Manager: Deepthi Unni Project Manager: Srividhya Vidhyashankar Design Direction: Patrick C. Ferguson Printed in India Last digit is the print number: 9 8 7 6 5 4 3 2 1 To my wife and best friend, Nicolette, who inspires me and loves me unconditionally, and our daughter Brooklyn, who amazes me each day. To my parents, Joseph and Ruth, who raised me to set no limits to my potential and my sister, Jennifer, who has always supported and appreciated me. Joseph R. Grajo, MD To my mentors, colleagues, and trainees, who challenge me and encourage my academic aspirations. Contributors Neha Agrawal, MD Richard G. Kavanagh, MB, BCh, BAO, BSc, MCh, FFRRCSI Abdominal Imaging Fellow Abdominal Imaging Fellow Department of Radiology Massachusetts General Hospital Massachusetts General Hospital Boston, Massachusetts Boston, Massachusetts United States United States David Knipp, MD Ahmad Al-Samaraee, MD, MPH Fellow Department of Radiology Department of Radiology Massachusetts General Hospital Massachusetts General Hospital Boston, Massachusetts Boston, Massachusetts United States Department of Radiology University of Minnesota Hamed Kordbacheh, MD Minneapolis, Minnesota Abdominal Imaging Research Fellow United States Department of Radiology Massachusetts General Hospital Mark Anderson, MD Boston, Massachusetts Abdominal Radiologist United States Massachusetts General Hospital Instructor Qian Li, MD Harvard Medical School Instructor of Radiology Boston, Massachusetts Department of Radiology United States Massachusetts General Hospital Boston, Massachusetts Masoud Baikpour, MD United States Diagnostic Radiology Resident Department of Radiology Weier Li, MD Massachusetts General Hospital Fellow Boston, Massachusetts Department of Radiology United States Massachusetts General Hospital Boston, Massachusetts Miguel Gosalbez, BS, MD United States Resident, Radiology Department of Radiology Babak Maghdoori, MD, FRCPC University of Florida Abdominal imaging specialist Gainesville, Florida Cardiothoracic imaging specialist United States Department of Medical Imaging Georgian Radiology Consultant Carolyn Hanna, BS, MD University of Toronto Resident, Radiology Toronto, Ontario University of Florida Canada Gainesville, Florida United States Laura L. Magnelli, MD Abdominal Imaging Fellow, PGY-6 Simon Ho, MD Department of Radiology Resident, Radiology Division of Abdominal Imaging University of Florida University of Florida College of Medicine Gainesville, Florida Gainesville, Florida United States United States iv Contributors v Craig Meiers, MD Jesse Rayan, MD Interventional Radiology Fellow Abdominal Imaging Fellow Department of Radiology Division of Abdominal Imaging University of Florida Massachusetts General Hospital Gainesville, Florida Boston, Massachusetts United States United States Aileen O’Shea, MB, BAO, BCh, FFRRCSI Justin Ruoss, MD Abdominal Imaging Fellow Physician Division of Abdominal Imaging Department of Radiology Massachusetts General Hospital University of Florida Boston, Massachusetts Gainesville, Florida United States United States Arinc Ozturk, MD Jehan L. Shah, MD Clinical Research Fellow Diagnostic Radiology Resident Department of Radiology Department of Radiology Massachusetts General Hospital University of Florida Boston, Massachusetts Gainesville, Florida United States Interventional Radiology Fellow Radiology Eric W. Pepin, MD, PhD Mayo Clinic Resident Jacksonville, Florida Department of Radiology United States University of Florida Gainesville, Florida Boris Sinayuk, MD United States Assistant Professor Department of Diagnostic Imaging John Pham, MD Warren Alpert Medical School Radiology, Resident Rhode Island Hospital Department of Radiology Providence, Rhode Island University of Florida United States Gainesville, Florida United States Joe Uricchio, MD Resident Theodore T. Pierce, MD Department of Radiology Instructor University of Florida Department of Radiology Gainesville, Florida Massachusetts General Hospital United States Boston, Massachusetts United States Vinay Prabhu, MD, MS Clinical Assistant Professor Department of Radiology NYU Langone Health New York, New York United States Series Foreword Congratulations to Dr Grajo, lead editor and co-editors, across the spectrum of what radiologists need to know Drs Sahani and Samir for producing Abdominal Imaging: from their first encounters with subject material in differ- The Core Requisites, the first book in the newly reimagined ent subspecialty areas, to studying for board exams and The Core Requisites series. Dr Grajo and colleagues assem- later for reference during clinical practice. The books in bled a stellar team of contributors and successfully piv- the The Core Requisites series will continue to be richly il- oted from a traditional narrative or prose-based approach lustrated; Abdominal Imaging: The Core Requisites has over for knowledge sharing to an outline format that immedi- 500 illustrations. The books are intended to be practical, ately brings forward and highlights the most important not encyclopedic. facts and concepts for each topic. The outline format Print and electronic formats will be produced simulta- makes the material covered readily accessible to readers, neously and included with each purchase. The electronic a key goal for anyone developing a textbook. Abdominal version will provide mobile access via multiple kinds of Imaging: The Core Requisites is outstanding and will serve devices and is searchable, adding additional value. This as a model for subsequent books in the series as they are approach is in keeping with our expectations in the inter- updated and revised. net age of access to knowledge at the time-of-need and Dr. Grajo and colleagues used the transition to the new point-of-care. “The Core Requisites” format to emphasize problem-based Congratulations again to Drs. Grajo, Sahani and Samir diagnostic scenarios to complement enduringly important for launching this new The Core Requisites series on a ter- material on anatomy, physiology, physics and imaging rific start. I hope that this and the following books in the methods. Using a problem-based approach in Abdominal series will become regarded with the same fondness as ear- Imaging: The Core Requisites allows presentation of material lier books in the Radiology Requisites family that have been in the way radiologists encounter diagnostic challenges in used by radiologists at all career stages now for over thirty actual practice including their relative importance and years. challenges in differential diagnosis versus a traditional tax- onomic approach that most often treats each disease or James H Thrall, MD condition one at a time and at the same level of emphasis Chairman Emeritus regardless of clinical prevalence. Department of Radiology, While the format of The Core Requisites series differs Massachusetts General Hospital substantially from the traditional Radiology Requisites Distinguished Taveras Professor of Radiology series, the philosophy remains the same—the production Harvard Medical School of a series of books covering the core material required Boston, Massachusetts vi Preface When Elsevier approached me about helping to relaunch but focused on the radiology trainee in preparation for the Requisites series, I was excited about the opportunity clinical rotations and board examinations. to contribute to the rebirth of a classic and fundamental Our approach to Abdominal Imaging: The Core Requisites radiology textbook. I was honored to be asked to spear- was to present focused “need to know” material in a format head a new abdominal imaging title, combining the con- that addresses commonly encountered clinical scenarios, tents of gastrointestinal and genitourinary radiology as such as right upper quadrant pain, chronic liver disease, seen in prior iterations. Furthermore, I was thrilled for and postoperative imaging. In each chapter, we review im- another chance to work with two of my most influential portant anatomy, discuss imaging techniques and protocol mentors and prestigious colleagues, Dr. Anthony Samir considerations, describe specific disease processes associ- and Dr. Dushyant Sahani. ated with the clinical scenario, summarize relevant tumor This textbook serves as a launch point for a rebranding of staging, and highlight key elements of a structured report. the Requisites series as “The Core Requisites.” In this series, We hope that you will enjoy this new venture in your we aim to present high-yield information in a concise for- journey of continuous learning. mat with easy-to-read chapters, targeting a wide audience Joseph R. Grajo, MD vii Contents SECTION I 17 Benign Focal Liver Lesions 135 Gastrointestinal Tract, 1 CRAIG MEIERS 1 Abdominal Radiography, 2 18 Cholecystitis, 146 WEIER LI BABAK MAGHDOORI AND HAMED KORDBACHEH 2 Gastrointestinal Fluoroscopy, 7 19 Jaundice, 156 WEIER LI BABAK MAGHDOORI AND HAMED KORDBACHEH 3 Gastric Wall Thickening/Masses, 12 SECTION III DAVID KNIPP Lymphatic System, 165 4 Hollow Viscus Perforation, 17 20 Splenomegaly/Splenic Lesions, 166 DAVID KNIPP ERIC W. PEPIN 5 Small Bowel Obstruction, 23 21 Lymphadenopathy, 173 JOHN PHAM AND SIMON HO JUSTIN RUOSS 6 Bowel Wall Thickening, 30 SECTION IV AHMAD AL-SAMARAEE Genitourinary, 182 7 Imaging of the Postoperative Bowel, 37 22 Urolithiasis, 183 JEHAN L. SHAH AND MIGUEL GOSALBEZ MARK A. ANDERSON 8 Mesenteric Ischemia, 47 23 Cystic Renal Masses, 188 RICHARD G. KAVANAGH LAURA MAGNELLI 9 Colorectal Cancer and Screening, 54 24 Solid Renal Lesions, 195 RICHARD G. KAVANAGH LAURA MAGNELLI AND CAROLYN HANNA 10 Right Upper Quadrant Pain, 62 25 Diffuse Renal Parenchymal Disorders, 204 NEHA AGRAWAL JESSE RAYAN 11 Right Lower Quadrant Pain, 72 26 Urinary Tract Obstruction, 215 NEHA AGRAWAL BORIS SINAYUK 12 Pancreatitis, 85 27 Urothelial Lesions, 221 JOHN PHAM AND SIMON HO BORIS SINAYUK 13 Solid Pancreatic Masses, 92 28 Adrenal Gland Enlargement and Nodules, 229 JEHAN L. SHAH AND MIGUEL GOSALBEZ ERIC W. PEPIN AND JOE URICCHIO 14 Cystic Pancreatic Lesions, 103 SECTION V JEHAN L. SHAH Reproductive System, 243 SECTION II 29 Prostate Imaging, 244 Hepatobiliary, 114 QIAN LI AND JOSEPH R. GRAJO 15 Chronic Liver Disease, 115 30 Testicular Lesions, 251 ARINC OZTURK QIAN LI 16 Imaging of the Cirrhotic Liver, 124 31 Endometrial/Junctional Zone Thickening, 259 ARINC OZTURK MASOUD BAIKPOUR viii