Differential Diagnosis in Conventional Radiology

879 Pages·2007·74.87 MB·English

by  Francis Burgener

Differential Diagnosis
in Conventional Radiology
Francis A. Burgener, MD Martti Kormano. MD Tom1 Pudas. MD
Professor of Rad1ology Formerly Professor and Cha1rman Department of Radiology
Umvers1ty of Rochester Department of Radiology Umvers1ty of Turku
Medical Center University of Turku Turku
Rochester. NY Turku hnland
USA
Finland
3rd cd1tion
2190 illustrations
Thieme
Stuttgart · New York
IV
Ubrary of Congre!>s Cataloging-in-Publication Data Important Note: Medicine is an ever-changing science
is available from the publisher. undergoing continu.ll development. Research and clinical
experience arc continually expanding our knowledge. in
particular our knowledge of proper treatment and drug ther ·
apy. Insofar as this book mt>ntions any dosage or application.
readers may rest assured that the authors. ed1tors. and pub
lishers have made every effort to ensure that such references
are in accordance with the state of knowledge at the time of
production of the book.
Nevertheless this docs not involve. imply. or express any
guarantee or responsibility on the pan of the publishers in
respect of any dosagl:' mstructions and forms of application
stated m the book. Every uSt'r is requested to examine cart>
fully the manufacturers· leaflet~ acrompanymg each drug
and to check. 1f necessary m con~ultauon with a phy~ician or
specialist. whether the dosage schedules mentioned therein
or the contraind1cations stated by the manufacturers differ
from the statements made in the present book. Such exami
nation is particularly important with drugs that are either
rarely used or have been newly released on the market.
Every dosage schedule or every form of application used is
entirely at the user's own risk and responsibility. The
authors and publishers request every user to report to the
publishers any discrepancies or maccuracies noticed.
C> 2008 Ceorg lhteme Vt'rlag, Some of the product names. patents. and registered des1gns
RlidtgerstraRe 14, 70469 Stuttgart, Germany referred to 1n this book are in fact registered trademarks or
http://www.thicml•.de proprietary names even though specific reference to this fact
is not always made in the text. Therefore. the appearance ofa
name without designation as proprietary is not to be con
Th1eme New York, 3B Seventh Avenue,
strued as a representation by the publisher that it is in the
New York. NY 10001. USA
public domain.
http: Jwww.th1en1e.com
Th1s book. mtluding all parts thereof, IS legally protected by
copyright. Any use. explo1tclt1on. or commercialization out
Typesetting by primustvpe llurler CmbH. side the narrow limits set by copyright legislation. without
D-73274 NotLingen the pubhsher's consent. is illegal and liable to prosecution.
Printed in Germany by Crammlith, Pliezha~n Th1s apphes in particular to photostat reproduction, copying.
mimeographing or duphcanon of any kind. translating. prep
ISBN 978-3-13-656103-4 (TPS. Rest of World) aranon of microfilms, and electronic data processing and
ISBN 978-1-58890-275-7 (TPN. The Americas) 1 2 3 4 56 storage.
v
Preface
Convt>nllonal r.ldtography remains the backbone of our ~pe­ tton constdered to be of lt'sc,er tmportance in the age or com
cialry desptre the advent of newer and posstbly more exCit puted tomography have been ehmmated to comply wtth the
ing tmagmg techmques such as computed tomography, mag publisher's request not to alter the overall volume of text.
netic resonance imaging, and, most recemly, posttron emts fhe chapter on mammography has been deleted because the
ston tomography. In contrast to many of these newer subJect could no longer be covered with the reqUired dPplh
methods. conventional radiography ts pract1ced not only by to be useful 10 the framework of thts text. In rhe rpma10mg
rad10log1sts but also by a large number of climcians and sur chapters. text ha~ been updated. many illusrratlons replan•d,
geons. Wtth each examination. one IS confronted with radio and a large number of new 1llu~trations added
logic findmgs that require interpretation in order to arrive at A "changmg of the guard" has also taken place Smce Dr.
a general dtagnosttc tmpresston and a reasonable dtffcrenttal Martti Kormano's professiOnal endeavors no lonrt"r mclude
diagnosis. To assist the film mterpreter m .Jttammg thts goal. clinical radtology, he was not able to take on the task of up
this book i~ b.l!>ed upon radiographic findings. unlike most dating his 011ginal contributions to the text. Fortunately for
other textbook~ m radiology that are disease oriented. Since all concerned, he was able to find in Dr. rom• Pudas a vt>ry
many disec1ses present radiographtcally m a v.Jnety of talented young radtologist to take ovt>r the revtsion of his
mantfestations. some overlap in the text •s unavoidable. To original chapters.
minimize repetttton, the differential diagno~is of a radio I hope this new r<'vtsed thtrd edition will IX' as well re
graphtc findmg is presented in tabular form whenever ceived as the previous ed1t1ons. The concept of an imag10g
fe.Jsible. Most tables hst not only the various d1~a~es that pattern approach m tabular form rather than a dtsease
may present radiologically m a specific pattern, but also de oriented text was Introduced 10 1985 with the first edmon of
scribe in succinct form other characteristi(ally cJSsoctated Differential D10gnosrs in Conventional Radzology and has s10ce
radiographic findings c1nd pertinent clinKal data. Rcldto been adopted by many authors. I take this as a compliment:
graphic illlustration~ and drawings are included to demon after all, tmllatton is the smcerest form of flattery.
strate visually the radiographic features under dtscusston. This book ts meant for physicians with some experience in
The transition from film to digital radiography hcls had a convt>ntional radiology who wish to strengthen their diag·
great impact on conventional radiology smce the publication nostic .1cumen. It is d wmprehensive outline of radiographic
of the ld~t editt on. Th1s ch.1nge, however. did not .1ffecr the findings and will be particularly useful to radiology residents
w.1y radtologtc dtagnoses are ascertained. Sinn~ the publica preparing for their SJX'Cidlist examination. espec•ally sim:e
tion of the last edition the n.1mes of a few diSOrders have the exposure to tonvemional radiogr.1phy during their train
ch.1nged (e. g., hl\tiotytosts X is now known as l.angNhans ing continuously decreased in the past in favor of newer im
tell hi~tiotytost\) and a few new diseases have been recog aging modahlles. Any physitian involved in the mterpretd
nized (e. g., femoroacetabular impmgement and severe tton of conventtondl radtographs should find tills book help
.!Cute rt>sptratory distress syndrome or SARS). These facts ful in dtre([ proponton to his or her curiosity.
were taken mto con~iderarion in thts new edttton. The chap lr is my hope that the third edition of Differeurial Diagnosts
ters "locali1ed Rone Lesions" and "jmnt Dtsease~> have been in Comentronol Radrology will prove as intrr~stmg as Its
completely r<'wntten and newly Illustrated since I rook them predecessor'> to medical students. residents. tddiologists,
over from Dr Kormano. The chapter "Trauma and Fractures" and physicians involvt>d m the Interpretation of conven
has also undergone a maJOr overhaul with the mdus1on of tional radtographs.
specific fracture mes Several chapters m the abdommal sec- Francis A. Rurgener. MD
VI
Acknowledgements
It IS impossible to thank individually all those who helped to Dr.jovitas Skucas, professor ementus, has provided me with
prepare the third edition of this textbook. I wish to acknowl a substantial number of gastrointe~tinal cases from his ex
edge the staff of our publisher Th1eme. m particular Dr. Clif quisite collection to replace or complement the illustrations
ford Bergman and Mr. Gcrt A. Kruger. I also appreciate the in this text. Following his retirement, Dr. Robert F. Spataro
willingness of Ms. Annu.• Hollins and Ms. Stefame Langner, donated his enure urogeOIIal teaching file to me. from which
both of whom were r<'Cently as~igned by Thieme to this pro I have selected a few outstanding cases for this new ed1tion.
ject to deal with my old-fashioned style relying mainly on I also wish to express many thanks to jill Derby, lona
pdper, pencils, hard copy, and the telephone. Mackey, and Marcella Ma1er for the1r assistance in preparing
I am deeply mdebted to Dr. Gertrud Collman, Stemach am the references and ro Sh•rley Cappiello for her general as
Attersee, Austna, who translated the last ed1tion of th1s text Sistance. Last, but not least. I am most grateful to Alyce
into German and suggested many alterations and correc Norder who left the Umversity and me after 30 years for the
tions which have been incorporated into this new edition. richness of the mdustry. She is the only person capable of
My gratitude goe!> to all the radiologists whose coopera deciphering my longhand dOd, .1s 10 the past, did a superb
tion made available Illustrative cases to complement the JOb 10 typing, editmg, and proofreading the manuscript of
ongmal collection or to replace older illustrations. I am in the new edition of this text. Despirl' her heavy workload as
debted to Drs. Stl•ven P. Meyers, johnny U.V. Monu, and Gwy executivl' assistant in her new endeavor, Alyce was kind
Suk Seo, all staff members of the University of Rochester enough to perform this task m her spare 11me, for which 1a m
Radiology Department, and to the former residents Drs. john deeply grateful.
M. Fitzgerald dnd Wael E.A. Saad for providing selected Fmally I apprcoate the support of my w1fe Therese, who
cases. has generously given her prec1ous family t1me for the pre
I greatly appreciate the invaluable contributions to this paration of th1s book.
project by two former faculty members of our department. francis A. Burgener. MD
I would hke to express my deepest gratitude to honorary radiology. The many fa~cinatiOg discu~~•ons I havl' had with
professor Marttl Kormano who mvlfed me to carry on his Drs. Seppo Kortelainen and Tel'mu Paav1lainen brought me
work in th1s new edition. I continue to admm~ the massive much delight. on non-radiological copies dS much as on pro
amount of work th.lt he and 01. Burgener originally put into fessional subjects.
the project m the early mneteen e1ghties. rhe hundred~ of I also express sincere thanks to the ~taff of the publishers.
hours wh1ch Dr. Kormano and I have spent together editing Th1eme. especially to D1. Chlford Bergman and Mr. Gert
this edition have been a great pleasure It was a fasc1natmg Kruger. f-Inally, much granrude 1s due to Mr. Markku
time in my life. Livanaien for his valuable asmtance with technical ques
I espcc1ally want to thank Drs. Kimmo Matt1la and Seppo tions. and to Ms. Pirjo llcl.mko for all her help with general
Koskinen for mtroducing me to musculoskeletal rad•ology, matters. Many othe• individual~ helped in various ways w1th
dnd for their extraordinary teachmg and support. Many th1s project. and though I cannot name them all.l am grateful
thanks also belong to Drs. l:rkki Svedstrom, Risro Elo. and for rhe•r conrnbut1ons.
Pt>ter B. Dean for encouraging me on my way m the field of Tomi Pudas. MD
VII
Contents
Bone ................................... .
1 Osteopenia • . • • . . . . . . . • . • • • • • . . . . . . . . . . 3 9 Orbits 233
• •••••• 0 •••••••••••••••••• ••• • 0 '
Francis A Burgener franm A. Burgener
2 Osteosclerosis • • • . . . . . . • • • . . . . . . . . . • . • . 15 10 Nasal F-ossa and Paranasal Sinuses .•....... 239
Francis A. Burgener Franrrs A. Burgener
3 Periosteal Reactions 41 11 Jaws and Teeth ........................ 247
Francrs A Burgener Francis A Burgener
4 Trauma and rractures . . . . . . . . • • . . . . . . . . . 53 12 Spine and Pelvis ......•..........•...•.. 257
Franos A Burgener Marter Kormano and lomr Pudos
5 localized Bone lesions 75 13 Clavicles. Ribs. and Sterman .............. 307
fronds A Burgener Martti Kormano and Tomi Pudas
6 Joint Diseases . . . . . . . . . . . • • . . . • . . . . . . . . . 129 14 Extremities .... ........... 315
Francis A. Burgener Francis A. BurJ{ener Marter Konnano.
and Tomi Pudus
7 Joint and Soft-l1ssue Calcification . . . . . . . . . 189
Martti Kormano and Tomi Pudas 15 Hands and Feet 355
•••••••••• ••••• • 0 ••• ••••
Martti Kormano and rorm Pudas
8 Skull .....••.••.•........•.•......... 203
Francis A Burgener
Chest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
16 Cardiac E:nlargement . . . . . . . . . • • • . . . . . . . 397 21 Interstitial lung 01sease • . • . . . . . . . . . . . . . . 513
Martti Kormano and Tomr Puda$ Francis A. Burgener
17 Mediastinal or Hilar Enlargement .•.•...... 437 22 Pulmonary fdema and Symml•tncal Bilateral
Martti Kormano and lomi Pudas Infiltrates . . . . . . . . . . . . . . . . . 537
Francis A. Burgener
18 Pleura and Diaphragm ..... .......•...... 465
Martti Kormano and Tomi Pudas 23 Pulmonary Nod 1les and Mass lesions 551
f"rancis A Burgener
19 Intrathoracic Calcifications . . . • • . . . . . . . . . . 477
Martti Kormano and lbmi Pudas 24 Pulmonary Cav1tary and Cy!>tlc les1ons . . . . . 569
Franos A Burgener
20 Alveolar Infiltrates and Atelectasis . . . . • . . . . 489
Francis A Burgener 25 Hyperlucent lung . . . . . . . . . . . . . . . . . . . . . . 583
Martti Kormano and Jorni Pudas
Abdomen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597
26 Abnormal Abdominal Gas Patterns and 29 Narrowmg in thC' Gastromtec;tinallract ..... 683
Dilatation and Motility Disorders in the Francis A. Burgener
Gastrointestinal Tract ..........•..•..... 599
Francis A Burgener and Martti Kormano 30 Filling Defects in the Ge~strointestinal Tract .. 713
Francis A. BuQ.:eller
27 Abdominal Calcifications . . . . . • . . . . • • . . . . . 631
Manti Kormano and francis A. Burgener 31 Ulcers, DivertiCula, and fistulas in the
Gastrointe'>tinal Tract .•..........•...... 747
28 Abnormal Mucosal Pattern in the Martli Kormano and Tomr Pudas
Gastrointestinal Tract .••................ 653
Martei Kormano and Tomi Pudas
VIII Contents
32 Gallbladder and Bile Duct Abnormaliltes .... 767 34 ftlltng Def£>cts in the Urinary Tratt ......... 789
FranCIS A Burgener franns A. Burgener
33 Abnormal Renal Papillae and Caltees ....... 781 35 Urinary Tract Obstruction and Dilatation .... 811
francil A Burgener Fruncis A. Burgener
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 839
Index .................................. 841
IX
Abbreviations
ABC .tncurysmal bone cyst IP mterph.tlangeal {jomt)
AC duomiocl.tvicular Uoint) IV
rntrdVtllOU~
ACTH adrenocorticotropic hormone IVC inferior vend c.tva
AIDS acquired immune deficiency syndrome L left
All dcute lymphoblastic leukemia LA left atrium
AML acute myeloblastic leukemia lCH Langer hdn\ u•ll hrsuocyrosrs
ANCA antmcutrophil cytoplasmouc auto.mtibodres lE lupus erythemdtosus
ANT ant error LIP lymphorclrnter~trrial pneumonrtis
AP anteropostenor ll lower lobe
APVR .tnomalous pulmon.try venous return lll left lower lobt'
ARDS dtute respiratory distress syndrome llQ left lower quadrant
ATN acute tubular neaosis lUl left upper lobe
AV drteriovenous lUQ lett upper qu.1drant
AVF arteriovenous fistula LV left ventnclc
AVM .trtenovenous malformatron M male
AVN .w.1scular necrosis MAl Mycobacterium avium rntracellulare
BOOP hronchiohus obliterans organrzing pneumonra MCP metacarpophalangeal Uomt)
BPOP brzarre parosteal osteochondromatous MFH mahgnant fibrous hisuo<.ytoma
proliferation Ml middle lobe
Bx biopsy MPS mucopoi)'Sdccharidosis
Ca caluum MR magnetic n.·sonance
CAD coronary artery disease MRJ magnetic resonance rmaging
CAM cysuc adenomatoid malfonnation MS multipll' sdl•ro~r~
CHF congestive heart failure MTP met.H.trsophalo~ngeal {joint)
OD cytomegalic rnclusion dise.tse NHL non·Hodgkrn lymphoma
Cll chronic lymphatic leukemia NUC nudear mt>dicine
CMV t ytomegalovi rus PA po\tt'IOalltl•rror
CNS <.entral nervous system PAI'VR partial anomalous pulmonary venous return
COP uyptogcnrc organizing pneumonia PATH pathology
COPD thronic obstruccive pulmonary drsea\e PAVM pulmonary artenovenous malforn1.1tron
CPP <..Jkium pyrophosphate drhydrate nystals PCP Pneumocy\tis carinii pneumonia
CPPD <.akrum pyrophosphate drhydrate deposrtron PDA patent ductus artenosus
disease PE pulmonary embolism
CRr-.10 chronic recurrent multrfocal osteomyelitis PET positron emr~sron tomography
(1 computed tomography PFFD proximal femoral focal deficiency
D drsea~e PIP proxrmal interphalc1ngeal {jomt)
uu drrterential dragnosis PNET primitive ncuroectodennal tumor
UDH development dysplasia of the hrp PO per orc1l
DIC drs~emrnatron mtravascular coagulauon PTlD post tran~plantc1tion lymphoproliferative
DIP desquamative interstitial pneumonitis disorder
DIP drstalmterphalangeal (joint) PVNS pigmentt'd villonodulc1r synovitis
DISH drffuse idiopathiC skeletal hyperostosis RA rrght c111 ium
DIS I dorsc1l intercalated segmental instability RA rhcumatord arthritis
EAC external auditory canal RBC red blood cc•ll
EG eosmophrhc granuloma RDS rewuatory di\tre\s \}'ndrome
F female RES ret it uloendothelial system
FAI femoro.tcetabular impingement Rll right lower lobe
GE ga\troesoph.Jgeal RSD rent•x '-YillPc1thetic dystrophy
Gl gJ\lrointesunal RUl rrght upper lobe
GIP grant cell interstitial pneumonitis RV rrght ventncle
GIST ~:astrointestin.JI stromal tumor SARS '>t'vere c1c ute re<>prratory distress \yndromc
HAD cdlnum hydroxyapatite crystals sc ~ternoc lavrwlc1r {jomt)
HADD c.Jinum hydroxyapatite crystal depo\IUOn disease Sl sacroiliac {joint)
Hb hemoglobin SLAC scapholunare .1dvanced collapse
HD Hodgkm drsec1se SLE systemrc lupus erythematosus
HIV human rmmunodeficrency vrrus sn sc .1 pholl .1 pe11otra pezordal
HRCT high-resolution CT lAI>VR total anomalous pulmonary venous retm n
Hx hrstory TB tubertulosis
lAC rnternal c1udrtory canal TfC tnangular fibrocartilage
IM mtramuscular TFCC trrangular fibrocartilage complex
X Abbrev•ations
us
TMJ tl'mporomand•bular JOint ultrasound
TNM turn or· nodl'-ml'tastasis UVJ ureterovesical junction
UIP u~ual intl'rstitial pnl'umonitis VCUG voiding ~tourethrogram
UPJ ur<'tt·ropelvic junction VIS I volar intcrcalatl'd spgml'ntal instability
1
Bone