Chest Radiology: The Essentials

352 Pages·2007·22.154 MB·English

by  Jannette Collins MD MEd, Eric J. Stern MD

P1:PBU/OVY P2:PBU/OVY QC:PBU/OVY T1:PBU Printer:MaplePress
GRBT226-FM Collins-Stern-3203G GRBT226-Collins-Stern-v7.cls July11,2007 0:30
CHEST RADIOLOGY
The Essentials
i
P1:PBU/OVY P2:PBU/OVY QC:PBU/OVY T1:PBU Printer:MaplePress
GRBT226-FM Collins-Stern-3203G GRBT226-Collins-Stern-v7.cls July11,2007 0:30
ii
P1:PBU/OVY P2:PBU/OVY QC:PBU/OVY T1:PBU Printer:MaplePress
GRBT226-FM Collins-Stern-3203G GRBT226-Collins-Stern-v7.cls July11,2007 0:30
CHEST RADIOLOGY
The Essentials
S E C O N D E D I T I O N
Edited By
Jannette Collins, , ,
MD MEd FCCP
ProfessorofRadiologyandMedicine
DepartmentofRadiology
UniversityofWisconsinSchoolofMedicineandPublicHealth
Madison,Wisconsin
Eric J. Stern,
MD
ProfessorofRadiology
AdjunctProfessorofMedicine
AdjunctProfessorofMedicalEducationandBioinformatics
Vice-ChairmanforAcademicAffairs
DirectorofThoracicImaging,HarborviewMedicalCenter
UniversityofWashington
Seattle,Washington
iii
P1:PBU/OVY P2:PBU/OVY QC:PBU/OVY T1:PBU Printer:MaplePress
GRBT226-FM Collins-Stern-3203G GRBT226-Collins-Stern-v7.cls July11,2007 0:30
AcquisitionsEditor:LisaMcAllister
ManagingEditor:KerryBarrett
MarketingManager:AngelaPanetta
ProjectManager:FranGunning
ManufacturingManager:BenRivera
ArtDirector:RisaClow
ProductionServices:Aptara,Inc.
(cid:2)C 2008byLIPPINCOTTWILLIAMS&WILKINS,aWoltersKluwerbusiness
(cid:2)C 1999,LippincottWilliams&Wilkins
530WalnutStreet
Philadelphia,PA19106
All rights reserved. This book is protected by copyright. No part of this book may be
reproduced in any form or by any means, including photocopying, or utilized by any infor-
mation storage and retrieval system without written permission from the copyright owner,
exceptforbriefquotationsembodiedincriticalarticlesandreviews.Materialsappearingin
thisbookpreparedbyindividualsaspartoftheirofficialdutiesasU.S.governmentemployees
arenotcoveredbytheabove-mentionedcopyright.
PrintedintheUnitedStatesofAmerica
LibraryofCongressCataloging-in-PublicationData
Collins,Jannette.
Chestradiology:theessentials/JannetteCollins,EricJ.Stern.—2nded.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN-13:978-0-7817-6314-1
1. Chest—Radiography. 2. Chest—Diseases—Diagnosis. I. Stern,EricJ. II. Title.
[DNLM:1. Radiography,Thoracic—methods. 2. LungDiseases—radiography.
3. ThoracicDiseases—radiography. WF975C712c2007]
RC941.c682007
617.5(cid:3)407572—dc22
2007018681
Care has been taken to confirm the accuracy of the information presented and to describe
generallyacceptedpractices.However,theauthors,editors,andpublisherarenotresponsible
for errors or omissions or for any consequences from application of the information in this
bookandmakenowarranty,expressedorimplied,withrespecttothecurrency,completeness,
oraccuracyofthecontentsofthepublication.Applicationofthisinformationinaparticular
situationremainstheprofessionalresponsibilityofthepractitioner.
Theauthor,editors,andpublisherhaveexertedeveryefforttoensurethatdrugselection
anddosagesetforthinthistextareinaccordancewithcurrentrecommendationsandprac-
ticeatthetimeofpublication.However,inviewofongoingresearch,changesingovernment
regulations,andtheconstantflowofinformationrelatingtodrugtherapyanddrugreactions,
the reader is urged to check the package insert for each drug for any change in indications
anddosageandforaddedwarningsandprecautions.Thisisparticularlyimportantwhenthe
recommendedagentisaneworinfrequentlyemployeddrug.
SomedrugsandmedicaldevicespresentedinthispublicationhaveFoodandDrugAdmin-
istration(FDA)clearanceforlimiteduseinrestrictedresearchsettings.Itistheresponsibility
ofthehealthcareprovidertoascertaintheFDAstatusofeachdrugordeviceplannedforuse
intheirclinicalpractice.
Topurchaseadditionalcopiesofthisbook,callourcustomerservicedepartmentat(800)
638-3030 or fax orders to [phone]. International customers should call (301) 223-
2300.
VisitLippincottWilliams&WilkinsontheInternet:http://www.LWW.com.Lippincott
Williams&Wilkinscustomerservicerepresentativesareavailablefrom8:30amto6:00pm,
EST.
10987654321
iv
P1:PBU/OVY P2:PBU/OVY QC:PBU/OVY T1:PBU Printer:MaplePress
GRBT226-FM Collins-Stern-3203G GRBT226-Collins-Stern-v7.cls July11,2007 0:30
To Mom and Dad (my first teachers),
sister Becki (my first playmate),
and husband Ken (my loving partner in
life with whom I would cycle to
the ends of the earth).
—JC
I dedicate this book to my amazing
children, Ethan, Kyra, and Sophie, who keep
my life in perspective.
—EJS
v
P1:PBU/OVY P2:PBU/OVY QC:PBU/OVY T1:PBU Printer:MaplePress
GRBT226-FM Collins-Stern-3203G GRBT226-Collins-Stern-v7.cls July11,2007 0:30
vi
P1:PBU/OVY P2:PBU/OVY QC:PBU/OVY T1:PBU Printer:MaplePress
GRBT226-FM Collins-Stern-3203G GRBT226-Collins-Stern-v7.cls July11,2007 0:30
F O R E W O R D
As a teacher of chest imaging I was delighted to see the sec- tables that summarize the most common causes of any given
ondeditionofChestRadiology:TheEssentials.Asinitsfirst radiographicabnormality.IparticularlyenjoyedChapter20,a
edition, the book is concise enough to read cover to cover in self-assessmentreviewthatwillbeparticularlyhelpfultoresi-
a short period of time yet comprehensive enough to include dentsandotherphysicianstoevaluatetheirknowledgeofthe
the essential aspects of thoracic imaging. The second edition coreaspectsofchestimaging.
includesneededupdatesandalargenumberofnewimages.It BothauthorshavecompletedtheAJRFigleyFellowshipin
isanimprovedversionofanexcellentbook. RadiologyJournalismandhaveconsiderableteachingandpub-
Thebookiseasytoreadandprovidesthereaderwiththe lishingexperience.Inaddition,Dr.Collinshasamaster’sdegree
basicknowledgerequiredtointerpretthechestradiographand ineducation.Theauthors’backgroundsandtalentsaswriters
theessentialCTfindings.Thefirsttwochaptersillustratenor- arereflectedintheclearoutlineofthebook’scontentsandthe
malanatomyandsignsofdisease.Theremainingchaptersfol- concise manner in which it provides a comprehensive review
low the pattern approach, the optimal approach to reach a ofthebasicsofchestradiology.
radiologic differential diagnosis. The book contains descrip-
tions of the essential patterns, relevant illustrations, and the NestorL.Mu¨ller,MD,PhD,FRCPC
mostimportantdifferentialdiagnosticconsiderations. ProfessorandChairman
Each chapter starts by delineating the learning objectives. DepartmentofRadiology
Chapterscontainschematicdrawingsthatgreatlyfacilitatethe UniversityofBritishColumbia
understanding of the various radiologic signs and numerous Vancouver,BritishColumbia,Canada
vii
P1:PBU/OVY P2:PBU/OVY QC:PBU/OVY T1:PBU Printer:MaplePress
GRBT226-FM Collins-Stern-3203G GRBT226-Collins-Stern-v7.cls July11,2007 0:30
viii
P1:PBU/OVY P2:PBU/OVY QC:PBU/OVY T1:PBU Printer:MaplePress
GRBT226-FM Collins-Stern-3203G GRBT226-Collins-Stern-v7.cls July11,2007 0:30
P R E FA C E
Givemefactsbutaboveallgivemeunderstanding. Thecontentofthesecondeditionwasexpandedtoinclude
—Solomon thenewclassificationoftheidiopathicinterstitialpneumonias,
current techniques used to evaluate solitary pulmonary nod-
The objective of this book is to provide a practical tool for
ules, guidelines for management of small incidental nodules
those wanting to quickly acquire a broad base of knowledge
detectedonchestCT,newWorldHealthOrganizationclassi-
inthoracicimaging.Thecontentislimitedtotheessentialsof
ficationoflungtumors,andnumerousnewimagingcasesfor
chestradiologysoasnottooverwhelmthenovice,yetprovides
self-assessment.
enoughdetailthatitcanserveasaquickreviewforresidents
Manycommentsfromreadersofthefirstedition,particu-
orpracticingradiologists,aguideforthosewhoteachthoracic
larly residents, were considered in preparing the second edi-
imaging, and a reference for internists, pulmonologists, tho-
tion. Those parts of the first edition that were positively re-
racic surgeons, critical care physicians, family practitioners,
garded,suchastheself-assessmentchapter,wereexpanded.A
and other health care professionals whose patients undergo
newsectionwasaddedon“PatternsofLungDisease”topro-
thoracicimagingprocedures.Whatsetsthisbookapartfrom
videaone-stopguidetotherecognitionandunderstandingof
other similar texts are (a) it is compact and of practical size
thefindingsofhoneycomblung,cysticlungdisease,interstitial
foraresidenttoreadduringaninitial4-weekchestradiology
nodules,mosaiclungattenuation,ground-glassopacification,
experience,(b)itcloselyfollowsanestablishedcardiothoracic
and“tree-in-bud”opacitiesonthin-sectionchestCT.
radiology curriculum, and (c) it provides an exercise for self-
To address the inherent limitations in a book of “essen-
assessment.
tials,” selected scientific literature and larger comprehensive
Thissecondeditioncarriesoverthepatternapproach,use
textbooksarereferencedattheendofeachchapterforreaders
of mnemonics, and emphasis on chest radiograph/CT cor-
whowanttobroadentheirfoundationofknowledge.Thein-
relation. However, several changes were made to the first
terpretationofchestradiographsandCTscansdoesnotalways
editiontoreflectcurrenttechnology(inparticular,theintroduc-
lenditselftoa“cookbook”approach,butasmuchaspossible,
tionoffastmultidetectorCTscanning)andupdatedcurricular
this book attempts to provide a logical approach to learning
guidelines.Thespecificbehaviorallybasedlearningobjectives
thatwillnotonlypreparereadersforbutalsostimulatethem
atthebeginningofeachchapterfollowthe2005revisedcur-
topursuelifelonglearninginchestradiology.
riculum on cardiothoracic radiology for diagnostic radiology
residencydevelopedbytheEducationCommitteeoftheSociety Reference
ofThoracicRadiology(1).Anewchapterdevotedtocardiac
imaging reflects the increased cardiac content in the revised 1.CollinsJ,AbbottGF,HolbertJM,etal.Revisedcurriculumoncardiothoracic
curriculum. radiologyfordiagnosticradiologyresidencywithgoalsandobjectivesrelatedto
Nearly800newimageswereaddedtothesecondedition, generalcompetencies.AcadRadiol.2005;12:210–223.
manyreplacingthosefromthefirsteditionthatreflectedolder
technology.Allofthenewfigureswereacquiredandtransferred JannetteCollins,MD,MEd,FCCP
tothepublisherindigitalformat. EricJ.Stern,MD
ix
P1:PBU/OVY P2:PBU/OVY QC:PBU/OVY T1:PBU Printer:MaplePress
GRBT226-FM Collins-Stern-3203G GRBT226-Collins-Stern-v7.cls July11,2007 0:30
x