Critical care radiology PDF
Preview Critical care radiology
Critical Care Radiology Cornelia Schaefer-Prokop, MD Associate Professor of Radiology Medical School Hanover, Germany Radiology Department Meander Medical Center Amersfoort Academic Medical Center (AMC) Amsterdam The Netherlands With contributions by M. Cejna, E. Eisenhuber-Stadler, M. Fuchsjaeger, G. Heinz-Peer, M. Hoermann, L. Kramer, S. Kreuzer, C. Loewe, S. Metz-Schimmerl, I. Noebauer-Huhmann, B. Partik, P. Pokieser, M. Prokop, T. Sautner, C. Schaefer-Prokop, W. Schima, E. Schober, A. Smets, A. Stadler, M. Uffmann, M. Walz, P. Wunderbaldinger 561 illustrations Thieme Stuttgart · New York LibraryofCongressCataloging-in-PublicationData Importantnote: Medicineisanever-changingscienceundergoing isavailablefromthepublisher. continual development. Research and clinical experience are continuallyexpandingourknowledge,inparticularourknowledge Thisbookisanauthorizedtranslationof ofpropertreatmentanddrugtherapy.Insofarasthisbookmentions theGermaneditionpublishedandcopyrighted2009by any dosage or application, readers may rest assured that the GeorgThiemeVerlag,Stuttgart, authors,editors,andpublishershavemadeeveryefforttoensure Germany.TitleoftheGermanedition: thatsuchreferencesareinaccordancewiththestateofknowledge RadiologischeDiagnostikinderIntensivmedizin. atthetimeofproductionofthebook. Nevertheless,thisdoesnotinvolve,imply,orexpressanyguarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms ofapplicationsstated inthebook. Everyuserisrequestedtoexaminecarefullythemanufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedulesmentionedthereinorthecontraindicationsstatedbythe manufacturersdifferfromthestatementsmadeinthepresentbook. Such examination is particularly important with drugs that are eitherrarelyusedorhavebeennewlyreleasedonthemarket.Every dosagescheduleoreveryformofapplicationusedisentirelyatthe user’s own risk and responsibility. The authors and publishers requesteveryusertoreporttothepublishersanydiscrepanciesor inaccuracies noticed. If errors in this work are found after publication, errata will be posted at www.thieme.com on the productdescriptionpage. Translator:TerryC.Telger,FortWorth,Texas,USA Illustrator:HelmutHoltermann,Dannenberg,Germany ©2011GeorgThiemeVerlag, Someoftheproductnames,patents,andregistereddesignsreferred Rüdigerstrasse14,70469Stuttgart,Germany to in this book are in fact registered trademarks or proprietary http://www.thieme.de nameseventhoughspecificreferencetothisfactisnotalwaysmade ThiemeNewYork,333SeventhAvenue, inthetext.Therefore,theappearanceofanamewithoutdesigna- NewYork,NY10001,USA tionasproprietaryisnottobeconstruedasarepresentationbythe http://www.thieme.com publisherthatitisinthepublicdomain. This book, including all parts thereof, is legally protected by copyright.Anyuse,exploitation,orcommercializationoutsidethe narrowlimitssetbycopyrightlegislation,withoutthepublisher’s Coverdesign:ThiemePublishingGroup consent,isillegalandliabletoprosecution.Thisappliesinparticular Typesettingby:DruckhausGötzGmbH, tophotostatreproduction,copying,mimeographing,preparationof Ludwigsburg,Germany microfilms,andelectronicdataprocessingandstorage. PrintedinChinabyEverbestPrintingLtd,HongKong ISBN978-3-13-150051-9 1 2 3 4 5 6 Contents This book is dedicated to my children V Foreword Preface Perhaps more than in any other setting, the interpreta- Consistentwithmyowninterests,thereaderwillno- tionofradiologicalimagesinpostoperativeandintensive tice a particular emphasis on illustrative radiographic care patients requires an interdisciplinary exchange of and CT images. I am indebtedtoall my friends and col- information, and cooperation between the radiologist leagues who contributed to this book, whether in the and the clinical team. The low specificity of many find- form of manuscripts or images. I thank the staff at ings—especially in bedside chest radiographs and post- Thieme Medical Publishers—especially Dr. S. Steindl and operativeabdominal studies—doesnotdiminishtheval- Dr.C.Urbanowicz—fortheirpatienceandhelpinbringing ue of intensive care radiology. Regular and active inter- thisprojecttocompletion.IamgratefultoProf.U.Moed- disciplinary information sharing will contribute greatly der for his personal support. I thank my husband, and to accurate image interpretation and resulting manage- especially my children, for their support, their patience, mentdecisions.Thisbookplacesspecialemphasis,there- and their understanding for the many hours of hard fore,onthedifferentialdiagnosisofmorphologicfindings work. and their interpretation within the clinical context, and I hope that this book will help radiologists, residents onaccuratelydiscriminatingbetweennormalandabnor- in radiology, and even clinicians to interpret the often malfindings. difficult and nonspecific findings in children and adults, Thequalityofradiographicimageshasimproveddra- andthatitwillhelptoadvanceinterdisciplinarycoopera- maticallyinrecentyearsasaresultofdigitaltechnology. tion in the diagnostic imagingof intensive care unit pa- Computed tomography (CT) has assumed an expanding tients. role owing to its rapid availability, short examination times,newindications,anditsunrivaleddiagnosticaccu- CorneliaSchaefer-Prokop racyand efficiency. This efficiency results notonly from short scan times, but also from the ability to image the bodyinarbitraryplanesofsection. VI Contributors Contributors Editor SoerenH.Kreuzer,MD AssistantProfessorofRadiology CorneliaSchaefer-Prokop,MD DepartmentofDiagnosticRadiology AssociateProfessorofRadiology MedicalUniversityofVienna MedicalSchoolHanover,Germany Vienna,Austria RadiologyDepartment ChristianLoewe,MD MeanderMedicalCenter AssociateProfessorofRadiology Amersfoort DepartmentofDiagnosticRadiology AcademicMedicalCenter(AMC) DivisionofCardiovascularandInterventional Amsterdam Radiology TheNetherlands MedicalUniversityofVienna Vienna,Austria ContributingAuthors SylviaMetz-Schimmerl,MD ManfredCejna,MD AssistantProfessor AssociatePofessorofRadiology DepartmentofDiagnosticRadiology Chairman,DepartmentofRadiology MedicalUniversityofVienna UniversityTeachingHospitalLKHFeldkirch Vienna,Austria Feldkirch,Austria Iris-M.Noebauer-Huhmann,MD EdithEisenhuber-Stadler,MD AssistantProfessorofRadiology DepartmentofRadiologyandDiagnosticImaging DepartmentofDiagnosticRadiology GöttlicherHeilandHospitalandHerz-Jesu-Hospital DivisionofOsteologyandNeuroradiology Vienna,Austria MedicalUniversityofVienna Vienna,Austria MichaelFuchsjaeger,MD AssociateProfessorofRadiology BernhardPartik,MD DepartmentofDiagnosticRadiology BrigittenauDiagnosticCenter MedicalUniversityofVienna Vienna,Austria Vienna,Austria PeterPokieser,MD GertraudHeinz-Peer,MD AssociateProfessorofRadiology AssociateProfessorofRadiology Chairman,MedicalMediaServices DepartmentofDiagnosticRadiology Vienna,Austria MedicalUniversityofVienna Vienna,Austria MathiasProkop,MD ProfessorofRadiology MarcusHoermann,MD Chairman,DepartmentofRadiology AssociateProfessorofRadiology RadboudUniversityNijmegenMedicalCenter DepartmentofDiagnosticRadiology Nijmegen,Netherlands MedicalUniversityofVienna Vienna,Austria ThomasSautner,MD AssociateProfessorofSurgery LudwigKramer,MD Chairman,DepartmentofSurgery AssociateProfessorofInternalMedicine St.ElisabethHospital MedicalClinicI Vienna,Austria HietzingHospital Vienna,Austria VII Contributors WolfgangSchima,MD,MSc MartinUffmann,MD AssociateProfessorofRadiology AssociateProfessorofRadiology Chairman,DepartmentofRadiology Chairman,DepartmentofDiagnosticRadiology GöttlicherHeilandHospitalandHerz-Jesu-Hospital LandesklinikumNeunkirchen Vienna,Austria Neunkirchen,Austria EwaldSchober,MD MichaelWalz,MD DepartmentofDiagnosticRadiology HessenCenterforQualityAssuranceinRadiology SocialMedicalCenterBaumgartnerHöhe LifeScienceGmbH OttoWagnerHospital Eschborn,Germany Vienna,Austria PatrickWunderbaldinger,MD AnneSmets,MD FavoritenDiagnosticCenter PediatricRadiologist Vienna,Austria DepartmentofRadiology AcademicMedicalCenter(AMC) Amsterdam,Netherlands AlfredStadler,MD DepartmentofRadiologyandNuclearMedicine HospitalHietzig Vienna,Austria VIII Abbreviations Abbreviations ALI acutelunginjury HPS hypertrophicpyloricstenosis AP anteroposterior HRCT high-resolutioncomputedtomography ARDS adult(acute)respiratorydistresssyndrome IAPB intra-aorticballoonpump ATS AmericanThoracicSociety ICD implantablecardioverterdefibrillator AV arteriovenous ICRP InternationalCommissiononRadiological BAL bronchoalveolarlavage Protection BPD bronchopulmonarydysplasia ICU intensivecareunit BPF bronchopleuralfistula IPPB intermittentpositivepressurebreathing CAP community-acquiredpneumonia IRDS infantilerespiratorydistresssyndrome CAPD chronicabdominalperitonealdialysis IVP intravenouspyelogram CCAM congenitalcysticadenomatoidmalformation LDH lactatedehydrogenase CDH congenitaldiaphragmatichernia LIS LungInjuryScore CK creatinekinase MAS meconiumaspirationsyndrome CLL chroniclymphoblastoid(lymphocytic) MCL midclavicularline leukemia MPR multiplanarreformation CMV cytomegalovirus MRI magneticresonanceimaging COP cryptogenicorganizingpneumonia MRSA methicillin-resistantStaphylococcusaureus COPD chronicobstructivepulmonarydisease NEC necrotizingenterocolitis CPAP continuouspositiveairwaypressure NOMI nonocclusivemesentericischemia CPIS ClinicalPulmonaryInfectionScore NSIP nonspecificinterstitialpneumonia CR computedradiography PA posteroanterior CT computedtomography PBB protectedbrushbronchoscopy CTDI computedtomographydoseindex PCN percutaneousnephrostomy CVC centralvenouscatheter PCP pneumocystispneumonia DAD diffusealveolarlavage PD pancreaticoduodenectomy DAP dose–areaproduct PE pulmonaryembolism DLP dose–lengthproduct PEEP positiveend-expiratorypressure DR digitalradiography PEG percutaneousendoscopicgastronomy DSA digitalsubtractionangiography PG prostaglandin EBV Epstein–Barrvirus PIE pulmonaryinterstitialemphysema ECG electrocardiography RAO rightanterioroblique ECMO extracorporealmembraneoxygenation RSV repiratorysyncytialvirus EPF esophagopleuralfistula SDD surfactantdeficiencydisease ETT endotrachealtube SLE systemiclupuserythmatosus FFD film–focusdistance TTN transienttachypneaofthenewborn FRC functionalresidualcapacity TUR transurethralresection GI gastrointestinal UAC umbilicalarterycatheter GvHD graft-versus-hostdisease UVC umbilicalveincatheter HFV high-frequencyventilation VAP ventilator-associatedpneumonia HIV humanimmunodeficiencyvirus VILI ventilator-inducedlunginjury HMD hyalinemembranedisease VZV varicella-zostervirus IX
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