Bone and joint disorders: differential diagnosis in conventional radiology PDF
Preview Bone and joint disorders: differential diagnosis in conventional radiology
I II III Bone and Joint Disorders Differential Diagnosis in Conventional Radiology Francis A. Burgener, M.D. Martti Kormano, M.D. Tomi Pudas, M.D. Professor of Radiology Formerly Professor and Chairman Department of Radiology University of Rochester Department of Radiology University of Turku Medical Center University of Turku Turku, Finland Rochester, N.Y., U.S.A. Turku, Finland 2nd revised edition 1108 illustrations Thieme Stuttgart · New York IV LibraryofCongressCataloging-in-PublicationData Important Note: Medicine is an ever-changing science un- isavailablefromthepublisher. dergoing continual development. Research and clinical ex- perience are continually expanding our knowledge, in par- ticularourknowledgeofpropertreatmentanddrugtherapy. Insofar as this book mentions any dosage or application, readersmayrestassuredthattheauthors,editorsandpub- lishershavemadeeveryefforttoensurethatsuchreferences areinaccordancewiththestateofknowledgeatthetimeof productionofthebook. 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PrintedinGermanybyGrammlich,Pliezhausen Thisappliesinparticulartophotostatreproduction,copying, mimeographingorduplicationofanykind,translating,prep- ISBN3-13-107392-6(GTV,Stuttgart) aration of microfilms, and electronic data processing and ISBN1-58890-445-8(TMP,NewYork) 12345 storage. V Preface Conventional radiography remains the backbone of went a major overhaul by the inclusion of specific fracture musculoskeletalradiologydespitetheadventofnewerand sites.Intheremainingchaptersofthebookthetextwasup- moreexcitingimagingtechniquessuchascomputedtomo- dated, many illustrations replaced, and large numbers of graphy, magnetic resonance imaging, and, most recently, newillustrationsadded. positronemissiontomography.Incontrasttomanyofthese A changing of the guard has also taken place. Since Dr. newer methods, conventional radiography is practiced not Martti Kormano‘s professional endeavors do no longer in- onlybyradiologistsbutalsobyalargenumberofclinicians cludeclinicalradiology,hefeltnolongerupthetasktoup- and surgeons. With each examination, one is confronted datehisoriginalcontributionstothetext.Hewashowever withradiologicfindingsthatrequireinterpretationinorder very fortunate to find in Dr. Tomi Pudas a very talented toarriveatageneraldiagnosticimpressionandareasonable young radiologist to take over the revision of the chapters differential diagnosis. To assist the film reader in attaining originallypreparedbyhim. thisgoal,thisbookisbaseduponradiographicfindingsun- Ihopethisneweditionwillbeaswellreceivedasitspred- like most other textbooks in radiology that are disease ecessors in the past that were translated into five foreign oriented.Sincemanydiseasespresentradiographicallyina languages. The concept of an imaging pattern approach in variety of manifestations, some overlap in the text is un- tabularformratherthanadiseaseorientedtextwasintro- avoidable.Tominimizerepetitionthedifferentialdiagnosis ducedin1985withouroriginaleditionDifferentialDiagnosis of a radiographic finding is presented in tabular form in Conventional Radiology and has since been adopted by whenever feasible. Most tables do not only list the various manyauthors.Ifeelcomplimentedbytheoldcliché,“imita- diseases that my present radiologically in a a specific pat- tionisthesincerestformofflattery.“ tern,butalsodescribeinsuccinctformothercharacteristi- Thisbookismeantforphysicianswithsomeexperiencein callyassociatedradiographicfindingsandpertinentclinical musculoskeletalradiologywhowishtostrengthentheirdi- data.Radiographicillustrationsanddrawingsareincludedto agnostic acumen. It is a comprehensive outline of radio- demonstrate visually the radiographic features under dis- graphicfindingsanditshouldbeparticularityusefultoradi- cussion. ology residents preparing for their specialist examination, The transition from film to digital radiography had the especially since the exposure to conventional radiography greatestimpactonconventionalradiologysincethepublica- during their training continuously decreased in the past in tionofthelastedition.Thischange,however,didnotaffect favorofnewerimagingmodalities.Anyphysicianinvolvedin thewayradiologicdiagnosesareascertained.Sincethepub- theinterpretationofconventionalboneradiographicexami- licationofthelasteditionthenameofafewdisordershas nationsshouldfindthisbookhelpfulindirectproportionto changed(e.g.,histiocytosisXtoLangerhanscellhistiocyto- hisorhercuriosity. sis) and a few disease are newly recognized (e.g., Itismyhopethatthisneweditionwillbeaswellreceived femoroacetabular impingement). These facts were taken asthepreviousonesbymedicalstudents,residents,radiolo- into account in the new edition. The chapters “Localized gists, and physicians involved in the interpretation of con- BoneLesions“and“JointDiseases“werecompletelyrewrit- ventionalboneradiographs. ten and newly illustrated, since I took them over from Dr. Kormano. The chapter “Trauma and Fractures“ also under FrancisA.Burgener,M.D. VI Acknowledgements Itisimpossibletothankindividuallyallthosewhohelpedto I wish to express also many thanks to Jeanette Griebel, preparethethirdeditionofthistextbook.Iwishtoacknowl- IonaMackey,andMarcellaMaierfortheirassistanceinpre- edgethestaffofourpublisherThieme,inparticularDr.Clif- paringthereferencesandtoShirleyCappielloforhergeneral fordBergmanandMr.GertA.Krüger. assistance. Last, but not least, I am most grateful to Alyce IamdeeplyindebtedtoDr.GertrudGollman,Steinacham NorderwholefttheUniversityandmeafter30yearsforthe Attersee,Austria,whotranslatedthelasteditionofthistext richness of the industry. She is the only person capable of into German and suggested many alterations and correc- deciphering my longhand and, as in the past, did a superb tions,whichhavebeenincorporatedintothisnewedition. job in typing, editing, and proofreading the manuscript of My gratitude goes to all the radiologists whose coopera- theneweditionofthistext.Despiteherheavyworkloadas tion made available illustrative cases to compliment the executive assistant in her new endeavor. Alyce was kind originalcollectionortoreplaceolderillustrations.Iamin- enoughtoperformthistaskinhersparetime,forwhichIam debtedtoDrs.StevenP.Meyers,JohnnyU.V.Monu,andGwy greatlyappreciative. Suk Seo, all staff members of the University of Rochester FinallyIappreciatethesupportofmywifeTherese,who RadiologyDepartment,andtotheformerresidentsDrs.John has generously given her precious family time for the pre- M. Fitzgerald and Wael E. A. Saad for providing selected parationofthisbook. cases. FrancisA.Burgener,M.D. I would like to express my deepest gratitude to honorary radiology.ThemanyfascinatingdiscussionsIhavehadwith professor Martti Kormano who invited me to carry on his Drs. Seppo Kortelainen and Teemu Paavilainen brought me workinthisnewedition.Icontinuetoadmirethemassive muchdelight,onnon-radiologicaltopicsasmuchasonpro- workthatheandDr.Burgeneroriginallyputintotheproject fessionalsubjects. intheearlynineteen-eighties.Thehundredsofhourswhich Ialsoexpresssincerethankstothestaffofthepublishers, Dr. Kormano and I have spent together editing this edition Thieme, especially to Dr. Clifford Bergman and Mr. Gert havebeenagreatpleasure.Itwasafascinatingtimeinmy Krüger. Finally, much gratitude is due to Mr. Markku life. Livanaien for his valuable assistance with technical ques- IespeciallywanttothankDrs.KimmoMattilaandSeppo tions,andtoMs.PirjoHelankoforallherhelpwithgeneral Koskinen for introducing me to musculoskeletal radiology, matters.Manyotherindividualshelpedinvariouswayswith and for their extraordinary teaching and support. Many thisproject,andthoughIcannotnamethemall,Iamgrateful thanks also belong to Drs. Erkki Svedström, Risto Elo, and fortheircontributions. PeterB.Deanforencouragingmeonmywayinthefieldof TomiPudas,M.D. VII Contents 1 Osteopenia........................... 3 10 Nasal Fossa and Paranasal Sinuses ........ 237 FrancisA.Burgener FrancisA.Burgener 2 Osteosclerosis ........................ 15 11 Jaws and Teeth ....................... 245 FrancisA.Burgener FrancisA.Burgener 3 Periosteal Reactions ................... 41 12 Spine and Pelvis ....................... 255 FrancisA.Burgener MarttiKormanoandTomiPudas 4 Trauma and Fractures .................. 53 13 Clavicles, Ribs, and Sternum............. 305 FrancisA.Burgener MarttiKormanoandTomiPudas 5 Localized Bone Lesions ................. 75 14 Extremities ........................... 313 FrancisA.Burgener FrancisA.Burgener,MarttiKormano, andTomiPudas 6 Joint Diseases......................... 129 FrancisA.Burgener 15 Hands and Feet ....................... 353 MarttiKormanoandTomiPudas 7 Joint and Soft-Tissue Calcification ........ 189 MarttiKormanoandTomiPudas References ............................... 392 8 Skull ................................ 203 Index ................................... 393 FrancisA.Burgener 9 Orbits ............................... 233 FrancisA.Burgener VIII Abbreviations ABC aneurysmalbonecyst IP interphalangeal(joint) AC acromioclavicular(joint) IV intravenous ACTH adrenocorticotropichormone L left AIDS acquiredimmunedeficienclysyndrome LCH Langerhanscellhistiocytosis ALL acutelymphoblasticleukemia LE lupuserythematosus AML acutemyeloblasticleukemia M male ANCA antineutrophilcytoplasmoticautoantibodies MAI Mycobacteriumaviumintracellulare ANT anterior MCP metacarpophalangeal(joint) AP anteroposterior MFH malignantfibroushistiocytoma AV arteriovenous MPS mucopolysaccharidosis AVF arteriovenousfistula MR magneticresonance AVM arteriovenousmalformation MRI magneticresonanceimaging AVN avascularnecrosis MS multiplesclerosis Bx biopsy MTP metatarsophalangeal(joint) Ca calcium NHL non-Hodgkinlymphoma CLL chroniclymphaticleukemia NUC nuclearmedicine CNS centralnervoussystem PA posteroanterior CPP calciumpyrophosphatedihydratecrystals PATH pathology CPPD calciumpyrophosphatedihydratedeposition PET positronemissiontomography disease PIP proximalinterphalangeal(joint) CRMO chronicrecurrentmultifocalosteomyelitis PNET primitiveneuroectodermaltumor CT computedtomography PVNS pigmentedvillonodularsynovitis D disease RA rheumatoidarthritis DD differentialdiagnosis RBC redbloodcell DDH developmentdysplasiaofthehip RES reticuloendothelialsystem DIP distalinterphalangeal(joint) RSD reflexsympatheticdystrophy DISH diffuseidiopathicskeletalhyperostosis SC sternoclavicular(joint) DISI dorsalintercalatedsegmentalinstability SI sacroiliac(joint) EAC externalauditorycanal SLAC scapholunateadvancedcollapse EG eosinophilicgranuloma SLE systemiclupuserythematosus F female STT scaphotrapeziotrapezoidal HAD calciumhydroxyapatitecrystals TB tuberculosis HADD calciumhydroxyapatitecrystaldepositiondisease TFC triangularfibrocartilage Hb hemoglobin TFCC triangularfibrocartilagecomplex HD Hodgkindisease TMJ temporomandibularjoint HIV humanimmunodeficiencyvirus TNM tumor-node-metastasis Hx history VISI volarintercalatedsegmentalinstability IAC internalauditorycanal WBC whitebloodcells IM intramuscular 1
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