Felson’s Principles of Chest Roentgenology: A Programmed Text

431 Pages·2020·109.231 MB·English

by  Lawrence Goodman

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SUPPLEMENT 1: Segmental Anatomy
This supplement is here for those interested in more anatomic detail.
SUPPLEMENT 2: Interstitial Lung Disease: A Picture Book
Using a series of pictures of everyday items, X-rays, and CTs, this is a pictorial explanation
of honeycombing, the reticular pattern, the nodular patterns, and so on.
SUPPLEMENT 3: Fleischner Society: Glossary of Terms for Thoracic Imaging
“Glossary of Terms for CT of the Lungs: Recommendations of the Nomenclature Committee
of the Fleischner Society”
BONUS QUIZ 1: More Unknown Cases: More Great Cases
Challenging Cases: Structured like the “Ten Great Cases” print quiz
BONUS QUIZ 2: More Unknown Cases: On Your Own
Sink or Swim: Brief history only, like the real world
BONUS QUIZ 3: Unknown Cases: The Ultimate Challenge—For Radiology Residents and Hard
Chargers
These are more difficult cases for radiology residents. Adventurous medical students may
also want to give them a try.
Video 1-1: Fluoroscopy
Video 2-1: Real time dynamic MRI (cine) of the heart is valuable for cardiac diagnosis
Video 2-2: Echocardiogram
Video q1-1: Middle-aged man with shortness of breath
Video q2-1: Chest X-ray shows several pulmonary nodules
Felson’s

PRINCIPLES
OF

CHEST ROENTGENOLOGY
FIFTH EDITION
Felson’s

PRINCIPLES
OF

CHEST ROENTGENOLOGY
A Programmed Text
Lawrence R. Goodman, MD, FACR
Professor Emeritus, Diagnostic Radiology and Pulmonary Medicine & Critical Care
Medical College of Wisconsin/Froedtert Memorial Hospital
Milwaukee, Wisconsin
Elsevier
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
FELSON’S PRINCIPLES OF CHEST ROENTGENOLOGY: ISBN: 978-0-323-62567-8
A PROGRAMMED TEXT
Copyright © 2021 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notice
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds or experiments described herein. Because of rapid
advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages
should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors,
editors or contributors for any injury and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of any methods, products, instructions,
or ideas contained in the material herein.
Previous editions copyrighted 2015, 2007, 1999
Library of Congress Control Number: 2019952357
Content Strategist: Joslyn Chaiprasert-Paguio
Content Development Specialist: Ann Ruzycka Anderson
Publishing Services Manager: Shereen Jameel
Senior Project Manager: Karthikeyan Murthy
Design Direction: Bridget Hoette
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To Hannah, Roy, Julie, Sarah, Sina,
and to the grandkids Noah, Zach, Zoey, and Jordy.
Preface
Almost 55 YEARS and going strong. It was 1965 when Felson, Weinstein, and Spitz first published
Principles of Chest Roentgenology. Since then, CT, MRI, ultrasound, and nuclear medicine have come
along, yet this modest book continues to be a best seller. Why?
Simple. The basic concepts are presented in a straightforward manner and logical sequence, one
chapter building on the next.
Relevant. The text emphasizes basic radiographic anatomy and signs of disease seen in everyday
practice. The chest x-ray is an important diagnostic tool in virtually every discipline in medicine.
Interactive. One cannot passively read this textbook. Active participation is engaging and entertaining,
and the material is more likely to be remembered. Now, with the electronic edition, interactivity is
better than ever.
Repetitive, repetitive, repetitive. Important concepts are presented and represented from various
points of view, reinforcing previously acquired knowledge.
Manageable. The open style and carefully selected material says to every harried reader, “This book
is doable.”
Fun. The science is easy! The humor is difficult! Much of the joy of the original text was the quips
and one-liners throughout the book. Principles in Chest Roentgenology proves that learning does not
have to be tedious. It strikes a balance between serious purpose and humor. Many remember the
jokes long after the details of left lower lobe anatomy have faded (probably not a terrible tragedy).
So what is new in the 5th edition?
- There are many new high-quality images, reflecting the improved imaging and printing technology
of the recent years.
- There are additional CT, MRI, and PET images as these technologies take a larger role in chest
imaging.
- The text and quizzes have been updated.
- There is a new picture book of high resolution chest CT for interstitial lung disease.
Thanks: I am most grateful to the many students and residents for their positive feedback over the
years and their helpful suggestions. Many thanks to my wife, Hannah, for her encouragement in
undertaking the Fifth Edition and to Ms. Carrie Gilbert, my senior administrative assistant, for her
great support and good counsel. In addition, I appreciate the hard work of Mr. Karthikeyan Murthy
and Ms. Ann Anderson from Elsevier. Zack Laste, third-year radiology resident at the Medical College
of Wisconsin, was nice enough to proofread the Fourth Edition and provide helpful feedback. He is
now a member of our chest radiology faculty. Additional thanks to Dr. Douglas Pierce, one of our
radiology residents who meticulously proofread this edition. Any residual mistakes are mine, not his.
LAWRENCE R. GOODMAN
viii
Instructions
Most of you are familiar with programmed learning. In the print version, the numbered frames on
the left require a response. Questions are designed, in most instances, to help you make the correct
response: the answer is often made clear by the frame itself or by what you have learned in earlier
frames. Answer by filling in the blanks or underlining where there are multiple choices. Use the mask
on the back cover of the book to hide answers on the right. We prefer you to write your answers in
ink so that your friends will have to buy their own copies. If you are using the e-version, just do it!
It is not essential that your answers be identical to ours, so long as the meaning is the same. If you miss
an answer, reread the frame so that you can be better prepared for what is to come. It is okay to cheat
by looking at the answers first, because it’s your money and time. Considering that your concentrated
attention is required, we suggest that you set a limit of an hour, at most, of consecutive study.
At the end of each chapter is a Review Quiz summarizing the most important concepts. Don’t skip
them. “Ten Great Cases,” the quiz that follows the last chapter, contains carefully selected x-rays
that allow you to apply your new knowledge.
After you finish the basic text, there are bonus chapters, additional unknowns, and other goodies in
the e-version.
Before going to Chapter 1, try the following samples.
1 This text is based on the reader’s participation. 1 (a) stupid, remove all
doubt
(a) Mark Twain once said, “It is better to keep your mouth
(b) wrong, right
shut and appear [stupid/smart] than to open it and
(c) b
___________.”
(b) Lee Rogers, MD, once said, “Don’t let the fear of being
[right/wrong] interfere with the joy of being ___________.”
(c) We expect you to adopt philosophy [a/b].
2 Understanding the anatomy and the radiographic signs are the 2 (a) watching
keys to reading x-rays. (b) know
(c) b (It’s my book!)
(a) “You’d be surprised how much you observe by
___________,” said Lawrence (Yogi) Berra.
(b) “You only see what you ___________,” says Lawrence
(Larry) Goodman, MD.
(c) This book was written based on assumption [a/b].
ix
Table of Contents
Felson’s Ten Axioms for a Lifetime of Learning in Medicine xiii
1 The Radiographic Examination: The Basics 1
2 Cross-Sectional Imaging Techniques 20
3 The Normal Chest X-Ray: Reading Like the Pros 36
4 Chest CT: Putting It All Together 58
5 Lobar Anatomy 74
6 The Silhouette Sign 94
7 The Air Bronchogram Sign 112
8 Signs of Lung and Lobar Collapse 126
9 Patterns of Lung Disease 152
10 Understanding the Mediastinum 178
11 The Pleural and Extrapleural Spaces 198
12 Cardiovascular Disease 222
Quiz: Ten Great Cases 241
Index 263
xi
xii Felson’s Principles of Chest Roentgenology
Bonus content available online at https://expertconsult.inkling.com*
Supplement 1: Segmental Anatomy
Supplement 2: Interstitial Lung Disease: A Picture Book
Supplement 3: Fleischner Society: Glossary of Terms for Thoracic Imaging
Bonus Quiz 1: More Unknown Cases: More Great Cases
Bonus Quiz 2: More Unknown Cases: On Your Own
Bonus Quiz 3: Unknown Cases: The Ultimate Challenge—For Radiology Residents and
Hard Chargers
*For more details, please see page adjacent to inside front cover