Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy PDF
Preview Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy
Dynamic Radiology of the Abdomen Normal and Pathologic Anatomy Third Edition Morton A. Meyers Dynamic Radiology of the Abdomen Normal and Pathologic Anatomy Third Edition With 1061 Illustrations, 14 in Full Color Springer Science+ Business Media, LLC Morton A. Meyers, M.D. Professor and Chairman Department of Radiology School of Medicine State University of New York at Stony Brook Stony Brook, New York 11794, USA ISBN 978-1-4757-3963-3 ISBN 978-1-4757-3961-9 (eBook) DOI 10.1007/978-1-4757-3961-9 Library of Congress Cataloging-in-Publication Data Meyers, Morton A. Dynamic radiology of the abdomen: normal and pathologic anatomy/ Morton A. Meyers.-3rd ed. p. cm. Includes bibliographie's and index. L Abdomen-Diseases-Diagnosis. 2. Abdomen-Radiography, I. Title. [DNLM: L Abdomen-anatomy & histology. 2. Abdomen-radiography. WI 900 M615d] RC944.M48 1988 617'.5507572-dcl9 DNLM/DLC for Library of Congress 87-28453 © 1979, 1982, 1988 by Springer Science+ Business Media New York Originally published by Springer-Verlag New York, Inc. in 1988 Softcover reprint of the hardcover 3rd edition 1988 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher, Springer Science+ Business Media, LLC, except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchan dise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed tobe true and accurate at the date of going to press, nei ther the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Typeset by Bi-Comp, Inc., York, Pennsylvania. 9 8 7 6 5 4 3 2 1 To my wife, Bea, and my children, Richard and Amy There are some things which cannot be learned quickly, and time, which is all we have, must be paid heavily for their acquiring. They are the very simplest things; and, because it takes a man's life to know them, the little new that each man gets from life is very costly and the only heritage he has to leave. ERNEST HEMINGWAY (1898-1961) Death in the Afternoon Foreword to First Edition Few books present so fresh an approach and so clear an exposition as does Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy. This well-documented, clearly written, and beautifully illustrated book details the answers not only to "what is it?" but also "how?" and "why?" Such fundamental information regarding the pathogenesis of disease within the abdomen reinforces and simplifies accurate radiologic analysis. The characteristic radiologic features of intraabdominal diseases are shown to be easily identified, expanding the practical application of the term "pattern recognition." It certainly is of practical value in daily clinical experience and will be of considerable help for further advances. The traditional dissectional method of learning anatomy disturbs the intimate relationships of structures. The sectional anatomy presented in this book is the framework for understanding the findings in conventional radiology-in plain films and routine contrast studies-as well as in ultrasonography and computed tomography of the abdomen. This is not just a review of others' experiences, but a crystallization of the au thor's contributions over the past several years. Dr. Meyers' concept of dynamic circulation within the peritoneal cavity is a breakthrough in our understanding of the spread of intraabdominal disease, particularly abscesses and malignancies. Peri toneography, the opacification of the largest lumen in the body, offers a potential yield of vast diagnostic information. The precise definition of the three extraperito neal spaces represents a charting of previously unexplored territory. Awareness of the renointestinal and duodenocolic relationships, the spread of pancreatitis along mesenteric planes, and the pathways of extra pelvic spread of disease again under scores the practical importance of anatomic features. The approach to the mesen teric and antimesenteric borders of the small bowel and to the haustral pattern of the colon adds a new dimension to the interpretation of abdominal radiology. This book confirms Dr. Meyers' reputation as one of the authorities in normal and pathologic radiologic anatomy of the abdomen. 1976 RICHARD H. MARSHAK, M.D. Clinical Professor of Radiology Mount Sinai School of Medicine New York City Foreword to First Edition Dr. Morton A. Meyers indeed has developed a dynamic text relating to radiologic aspects of abdominal disease. But this statement, with its emphasis on radiology, is misleading. This book is an important reading source for surgeons. Dr. Meyers' observations have not been confined to those arising from a purely radiologic study of the abdomen. The inclusion of observations based on injection studies both in the cadaver and in vivo has given this work a noteworthy comprehensiveness. The insights provided by both the atlas of full-page color anatomic cross sections of the abdomen and pelvis and the excellent anatomic-radiologic correlations found in the text make the book indispensable. The atlas establishes the basis for intimate anatomic relationships which are then applied to the practical areas of clinical diagnosis and treatment of intraabdominal pathology. Presentations of these diagnostic and therapeutic considerations are enhanced by illustrated discus sions relative to the new techniques of ultrasonography and computed tomog raphy. Dr. Meyers' presentation of this timely information is valuable, but what makes this book invaluable is the vast personal experience he is able to bring to it. This is not 'just another" book purporting to give us something new in this important field. I believe the special approach given to this subject by Dr. Meyers is truly innovative. The radiologist and surgeon looking for the latest techniques in angiography for the diagnosis and treatment of massive bleeding from the gastrointestinal tract will not find it here. What they will find is major help in the understanding of, and indeed, therapeutic approach to a number of common intraabdominal problems, including infection and malignancy. 1976 LLOYD M. NYHUS, M.D., F.A.C.S. Warren H. Cole Professor and Chairman, Department of Surgery The Abraham Lincoln School of Medicine University of Illinois at the Medical Center Chicago, Illinois Preface to Third Edition The clinical insights and rational system of diagnostic analysis stimulated by an appreciation of the dynamic intraabdominal relationships outlined in previous edi tions of Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy have been universally adopted. Spanish and Japanese editions have encouraged more wide spread applications of the principles which in turn have led to further contribu tions to our understanding of the features of spread and localization of intraab dominal diseases. The basic aims in writing this book have not changed from those cited in the Preface to the First Edition. To satisfy these aims, special attention has been given to updating and revision with the addition of new material covering advances in the six years since the publication of the Second Edition. This edition contains over 230 new illustrations. Some nonessential material has been eliminated and several illus trations have been judiciously rearranged. Many of the Second Edition's illustra tions have been replaced with better images and improved line drawings. The presentation of new material is amply supported by highly selected images, includ ing particularly computed tomography (CT) and a few relevant magnetic reso nance images. As in previous editions, although a few of the illustrations may not be of the very highest quality, the reader will understand they have been carefully selected for the particular abnormality or dynamic principle demonstrated. Advances in appreciation of normal anatomic relationships and variants include the lobar anatomy of the liver, the structural relationships of the porta hepatis and its contents, and the developmental distortion of the adrenal glands in association with certain renal anomalies. Developments in understanding the intraperitoneal spread of infections include the CT anatomy of the lesser sac, ligamentous demarcations of subphrenic ab scesses, and the spread of abscesses following surgical transection of anatomic ligamentous barriers. Concepts of the pathways of dissemination of malignancies have been highly expanded by identification of the peritoneal ligaments and me senteries as avenues for direct spread; indeed as bridging structures between what has been conventionally thought of as extra peritoneal and intraperitoneal tissues, these lead to a unifying concept of the subperitoneal space of the abdomen. Fur ther advances in the understanding of the intraperitoneal spread of malignancies include the illumination of seeded perihepatic and subdiaphragmatic metastases and of certain aspects of lymphatic permeation. Numerous major developments have also refined our precise evaluation of the extra peritoneal fascia and spaces. Among these are further discrete identification of the landmarks and insertions of the renal fascia and their anatomic demarcation Xl xu of spaces; the appearance and causes of thickening of the renal fascia; the composi tion of the posterior renal fascia into two layers and the consequences of pancreati tis with its extension to produce the Grey-Turner sign; bridging renal septa; fur ther features of spread through the anterior pararenal space; CT features of uriniferous perirenal pseudocyst; and rupture of abdominal aortic aneurysms. The references have been considerably expanded and yet carefully selected, citing both classic articles and recent contributions. A lengthy index with cross references provides immediate access to the detailed material presented. Many persons have contributed importantly to the Third Edition and I thank them sincerely. I wish to express my particular appreciation to Michael Oliphant, M.D. and Alfred S. Berne, M.D., Crouse-Irving Memorial Hospital, State Univer sity of New York, Syracuse, New York and to Michiel Feldberg, M.D., Ph.D., of the University of Utrecht, The Netherlands. They have offered selfless cooperation and the stimulating pleasure of sharing intellectual enthusiasms. I submit this third manuscript to Springer-Verlag, confident that their skills will produce another edition of high technical quality. 1988 MORTON A. MEYERS, M.D. Preface to First Edition This book provides a systematic application of anatomic and dynamic principles to the practical understanding and diagnosis of intraabdominal diseases. Anatomic sections and irBection studies form a basis for understanding the characteristic features of many common and uncommon diseases and their spread and localiza tion in the abdomen. These relationships and specific criteria provide a rational system for accurate radiologic analysis in plain films, conventional contrast studies, ultrasonography, and computed tomography (CT). This information leads to the uncovering of clinically deceptive diseases, the evaluation of the effects of disease, the anticipation of complications, and the determination of the appropriate diag nostic and therapeutic approaches. The introductory atlas presents full-color anatomic cross-sections of the abdo men and pelvis, complemented by labeled tracings, and detailed CT scans at corre sponding levels. The sections, which are approximately 3.8 cm (1.5 in.) thick, were obtained from fresh cadavers frozen in dry ice for 48 hours, in order to maintain the true intimate anatomic relationships. The accompanying text of the atlas stresses normal gross relationships, common variants, and the basis of their radio logic identification, particularly in plain films. The subsequent chapters deal with the diagnosis and the pathways of spread of infection, malignancies, and traumatic and inflammatory effusions within the intra- and extra peritoneal spaces. Emphasis is placed on the specific localizing features based on the anatomic planes and recesses and the dynamics of extension of disease. Sagittal and coronal as well as horizontal anatomic sections support the findings in conventional radiologic proce dures, ultrasonography, and computed tomography throughout. Correlation with the clinical findings and management underscores the value of the radiologic ob servations. Diagnostic criteria which are easily applied are established for the char acteristic features of specific disease processes ranging from localized abscesses to disseminated metastases. Many of the insights detailed in this book have been made only in the past few years. The application of peritoneography as a clinical diagnostic study, for exam ple, first indicated the dynamic circulation of fluid states within the peritoneal recesses and permitted an insight into the spread of infection and malignancies. Similarly, the significance of the anatomic and radiologic definition of the extra peritoneal spaces, the small bowel mesentery and other peritoneal reflections, the haustral contours of the large intestine, and the contiguity of certain organ rela tionships has only recently been appreciated. 1976 MORTON A. MEYERS, M.D.
The list of books you might like
