Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy

794 Pages·2005·329.14 MB·English

by  Morton A. Meyers (auth.)

Dynamic Radiology
of the Abdomen
FIFTHEDITION
Springer
NewYork
Berlin
Heidelberg
Barcelona
Hong Kong
London
Milan
Paris
Singapore
Tokyo
Morton A. Meyers
With Contributions by Stephen R. Baker, Alfred S. Berne, Chusilp Charnsangavej,
Kyunghee C. Cho, Michiel A.M. Feldberg, Bruce Javors, Hiromu Mori,
Michael Oliphant, Catherine Roy, Maarten S. van Leeuwen, Ronald Wachsberg
Dynamic Radiology
of the Abdomen
Normal and Pathologic Anatomy
F E
IFTH DITION
With 1133 Figures in 1796 Parts, 18 in Color
Springer
eBookISBN: 0-387-21804-1
Print ISBN: 0-387-98845-9
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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
Death in the Afternoon
The greatest thing a human soul ever does in this world
is to see something. . . . To see clearly is poetry, prophecy,
and religion, all in one.
John Ruskin
Modern Painters
Preface to the
Fifth Edition
The preface to the first edition of Dynamic Radiology of range of imaging studies including plain films, tomo–
the Abdomen: Normal and Pathologic Anatomy stated that grams, and conventional contrast studies; presacral ret–
this book introduces a systematic application of ana- roperitoneal pneumography and peritoneography; sin-
tomic and dynamic principles to the practical under- ography which occasionally provided serendipitous
standing and diagnosis of intraabdominal diseases. The display of normal and pathologic anatomy akin to an in
clinicalinsights and rational system of diagnostic analysis vivo model; and computed tomography, ultrasonog-
stimulated by an appreciation of the dynamic intraab- raphy, nuclearmedicinestudies, magnetic resonance im-
dominal relationships outlined in previous editions have aging, and endoscopic ultrasonography; (d) peritoneos-
been universally adopted. Literally thousands of scien- copy; and (e) surgical operations, surgical pathology and
tific articles in the literature have attested to their basic autopsies.
precepts. Formulations and analytic approaches intro- The basic aims in writing this book have not changed
duced in the first edition are now widely applied in from the first edition and it is produced in the same
clinical medicine so that many of the terminologies, def- spirit as its predecessors. The quest of science has always
initions, and concepts of pathogenesis have solidly en- sought the identification of a pattern of circumstances.
tered the public domain. These insights lead to the un- With this recognition, there follows insight and under-
covering of clinically deceptive diseases, the evaluation standing into the nature and dynamics of events and
of the effects of disease, the anticipation of complica- thereby their predictability, management, and conse-
tions, and the determination of the appropriate diag- quences. This book establishes that the spread and lo-
nostic and therapeutic approaches. Spanish, Italian, Jap- calization of diseasesthroughout the abdomen and pelvis
anese, and Portuguese editions have encouraged more are not random, irrational occurences but rather are
widespread application of the principles which in turn governed by laws of structural and dynamic factors.
has led to further contributions to our understanding of To satisfy these aims, special attention has been given
the features of spread and localization of intraabdominal to keeping the book current with clinical and techno-
diseases. These principles have been applied to the full logical advances that have so dramatically altered the
range of imaging modalities—from plain films and con- practice of abdominal imaging in the past several years.
ventional contrast studies to CT, US, MRI and endo– Six completely new chapters have been added and vir-
scopic, laparoscopic, and intraoperative ultrasonog- tually all others have been extensively updated and en-
raphy—leading to this fifth edition in 24 years. larged. This edition is expanded by more than 180 pages
In the pursuit of comprehending the pattern, all and more than 520 new illustrations.
methods of investigation have been used, including (a) Many of the new chapters are by international au-
anatomic cross–sectioning of cadavers frozen to maintain thorities who have pioneered advances in the crucial
relationships; (b) cadaver injections and dissections per- appreciation and precise recognition of a wide spectrum
formed to determine preferential planes of spread along of intraabdominal diseases. An introductory chapter on
ligaments, mesenteries and extraperitoneal fascial com- general considerations underscores the book’s continu-
partments; (c) selected clinical cases with the fullest ing thematic approach based upon anatomic relation-
viii Preface to the Fifth Edition
ships, dynamic factors, and visual perception of the im- uum; this holistic concept provides an explanation for
age. This is followed by a chapter on clinical what has long been thought of as illogical circumstances.
embryology, emphasizing an understanding of disease Numerous major developments have also refined our
entities which often are only first clinically apparent in precise evaluation of the extraperitoneal fascia and
the adult. The manifestations of intraperitoneal air, often spaces. A new section defines the compartmentalization
subtle on plain films but nevertheless highlysignificant, of the anterior pararenal space, in keeping with pro-
are precisely described and illustrated. A new chapter is gressive application of embryologic/anatomic circum-
devoted to oncoradiology and the TNM staging of gas- stances to clinical imaging. The section on the extra-
trointestinal cancers, delineating the normal anatomic peritoneal paravesical pelvic spaces and their continuities
mural components by sectional imaging and the extent with the abdominal spaces has been refined and ex-
of intramural and regional neoplastic spread. Other panded. Fundamental anatomic characteristics of the
chapters deal with the discrete identification of the path- fascia and spaces are documented and their clinical rele-
ways of lymph node metastases in cancers of the gastro- vance richly illustrated. These include the potential
intestinal and hepatobiliary tracts and the pathways of midline communication of the perirenal spaces, the in-
regional spread in pancreatic cancer. ferior apex of the cone of renal fascia, the retromesen-
Developments in understanding the intraperitoneal teric plane, the attachment of the adrenal gland to the
spread of infections include the normal and pathologic renal fascia superiorly, and the identification of the two
anatomy of the lesser sac. Features of the significance of lamellae of the posterior renal fascia. Further enlarged
the gastropancreatic plica, the superior and lower reces- are the discussions and illustrations of the lumbar tri-
ses of the lesser sac, and the imaging features of the di- angle pathway and its relationship to GreyTurner’ssign
mensions and relationships of the foramen of Winslow in pancreatitis and retrorenal hemorrhage; and of exten-
are detailed. The clinical significance of the spread of sion along the perihepatic ligaments and its relationship
infection via the perihepatic ligaments is greatly ex- to Cullen’s sign. Occasional instances of splenic trauma
panded. leading to clinically masked extraperitoneal bleeding are
Concepts of the pathways of dissemination of malig- explained. Staging of renal cell carcinoma is significantly
nancieshave beenhighly expanded and richly illustrated updated, with comparison of Robson’s classification and
with the full range of imaging modalities. Normal and the TNM system and the value of magnetic resonance
pathologic anatomy are made graphic by spiral CT with imaging. Perirenal diseases beyond abscesses and hem-
planar reconstructions, MR, endoscopic ultrasonog– orrhage have been expanded to include perirenal me-
raphy and laparoscopic ultrasonography. The position tastases, lymphoma, extramedullary hematopoiesis and
and nomenclature of lymph node stations in gastric car- retroperitoneal fibrosis. The anatomy of the iliopsoas
cinoma as classified by the Japanese Research Society compartment is clarified and the features of psoas abscess
for Gastric Cancer have been updated and correlation is are illustrated. Controversies regarding rupture of ab-
made with the TNM staging system. Further advances dominal aortic aneurysms with extension of hemor-
in the understanding of the intraperitoneal spread of ma- rhage to the extraperitoneal spaces are resolved.
lignancies include features of seeded perihepatic and Other additions include discussions of renocolic fis-
subdiaphragmatic metastases, subcapsular liver metasta- tulas; the precise anatomy and importance of the liga-
ses, spread to anterior mediastinal lymph nodes, implan- ment of Treitz; characteristic localizing features of
tation on the falciform ligament and within the inter- scleroderma, carcinoid and Crohn disease of the small
hepatic fissures, hepatic invasion by advanced gastric bowel; and the CT features and differential diagnosis of
cancer, Sister Mary Joseph’s nodule, Krukenberg tumors internal paraduodenal hernias.
of the ovaries, the pathogenesis and differential diagnosis While diagnostic criteria are emphasized throughout
of the omental cake and of peritoneal thickening and the book, there is also discussion of foreseeable compli-
enhancement in peritoneal carcinomatosis; instrumen- cations and appropriate management of many disease
tal, operative and needle track seeding; hematogeous processes.
metastases to the small bowel from metastatic melanoma, As in previous editions, greatcare has been taken with
breast carcinoma and bronchogenic carcinoma. Devel- the layout to give prominence to selected illustrations
opments and advances in imaging the spread and local- and, most importantly, to position the figures as closely
ization of intraperitoneal malignancies are discussed and as possible to their citation in the text so that the reader’s
illustrated. The unifying perspective of the subperito- time and effort are not wasted referring to pages some
neal space of the abdomen and pelvis, establishing the distance apart.
discrete planes of subserous connective tissue and lym- The color atlas details anatomic features of clinical
phatics, is extended to the thoraco-abdominal contin- significance.
Preface to the Fifth Edition ix
The references have been considerably expanded and polis, Indiana; Hiromu Mori, M.D., Oita Medical Uni-
continue to include both classic articles and recent ci- versity, Oita, Japan; Michael Oliphant, M.D., Crouse
tations. They are not restricted to the English language Hospital, State University of New York, Syracuse, New
and, when pertinent, refer to the original descriptions. York; Richard C. Semelka, M.D., University of North
A lengthy index with cross-references provides imme- Carolina Hospitals, Chapel Hill, North Carolina; Ann
diate access to the detailedmaterial presented. Singer, M.D., Cleveland Clinic Foundation, Cleveland,
Many persons have contributed importantly to the Ohio, and Francis Weill, M.D., University of Besançon
fifth edition and I thank them sincerely. I wish to express School of Medicine, Besançon, France for their contri-
my particular appreciation to Angel Arenas, M.D., Hos- butions. Additionally, I wish to express my gratitude to
pitalUniversitario “12 de Octubre,” Madrid,Spain; Yong the contributing authors who have added luster to this
Ho Auh, M.D., Asan Medical Center, Seoul, Korea; Emil edition.
Balthazar, M.D., New York University School of Medi- I am distinctly grateful to Michiel A. M. Feldberg,
cine, New York City; James Brink,M.D., Yale University M.D., Ph.D., University Hospital, Utrecht, Nether-
Medical School, New Haven, Connecticut; Gary G. lands, for his selfless cooperation and the stimulating
Ghahremani, M.D., Evanston Hospital—Northwestern pleasure of sharing intellectual enthusiasms.
University, Evanston, Illinois; Jay P. Heiken, M.D., Mal- I have submitted this fifth manuscript to Springer-
linckrodt Institute of Radiology, St. Louis, Missouri; Verlag, confident that their skills have produced another
Dean T. Maglinte, M.D., Methodist Hospital, Indiana- edition of high technical quality.
Morton A. Meyers, M.D.
Stony Brook, New York
January, 2000
Foreword to
First Edition
Few books present so fresh an approach and so clear an This is not just a review of others’ experiences, but a
exposition as does Dynamic Radiology of the Abdomen: crystallization of the author’s contributions over the past
Normal and Pathologic Anatomy. several years. Dr. Meyers’ concept of dynamic circula-
This well-documented, clearly written, and beauti- tion within the peritoneal cavity is a breakthrough in
fully illustrated book details the answers not only to our understanding of the spread of intraabdominal dis-
“what is it?” but also “how?” and “why?” Such fun- ease, particularly abscesses and malignancies. Perito-
damental information regarding the pathogenesis of dis- neography, the opacification of the largest lumen in the
ease within the abdomen reinforces and simplifies ac- body, offers a potential yield of vast diagnostic infor-
curate radiologic analysis. The characteristic radiologic mation. The precise definition of the three extraperi-
features of intraabdominal diseases are shown to be easily toneal spaces represents a charting ofpreviously unex-
identified, expanding the practical application of the plored territory. Awareness of the renointestinal and
term “pattern recognition.” It certainly is of practical duodenocolic relationships, the spread of pancreatitis
value in daily clinical experience and will be of consid- along mesenteric planes, and the pathways of extrapelvic
erable help for further advances. spread of disease again underscores the practical impor-
The traditional dissectional method of learning anat- tance of anatomic features. The approach to the mes-
omy disturbs the intimate relationships of structures. enteric and antimesenteric borders of the small bowel
The sectional anatomy presented in this book is the and to the haustral pattern of the colon adds a new di-
framework for understanding the findings in conven- mension to the interpretation of abdominal radiology.
tional radiology—in plain films and routine contrast This book confirms Dr. Meyers’ reputation as one of
studies—as well as in ultrasonography and computed to- the authorities in normal and pathologic radiologic
mography of the abdomen. anatomy of the abdomen.
1976 Richard H. Marshak, M.D.
Clinical Professor of Radiology
Mount Sinai School of Medicine
New York, New York