Pediatric Body CT

372 Pages·1987·18.536 MB·English

by  Alan Daneman MBBCh, BSc, MRACR, FRCP(C) (auth.)

Alan Daneman
Pediatric
BodyCT
With 317 Figures
Springer-Verlag
London Berlin Heidelberg New York
Paris Tokyo
Alan Daneman, MBBCh, BSc, MRACR, FRCP(C)
Associate Professor of Radiology,
University of Toronto, Ontario, Canada.
Staff Radiologist, Head, Division of Ultrasound and Body CT
Department of Radiology, The Hospital for Sick Children,
555 University Avenue, Toronto, Ontario M5G lX8, Canada
ISBN-13:978-1-4471-3139-7 e-ISBN-13:978-1-4471-3137-3
DOl: 10.1007/978-1-4471-3137-3
Library of Congress Cataloging-in-Publication Data
Daneman, Alan, 1947-
Pediatric body CT.
Includes bibliographies and index.
1. Tomography. 2. Pediatric radiography. 1. Title. [DNLM: 1. Tomography, X-Ray Computed
- in infancy and childhood. WN 240 D179p] RJ51.T65D36 1986 618.92'007'572 86--3795
ISBN-13:978-1-4471-3139-7 (U.S.)
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© Springer-Verlag Berlin Heidelberg 1987
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Dedicated to Louise,
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Preface
Pediatric body CT began in earnest in 1976 when for the first time a body CT machine
was installed in a pediatric institution, the Hospital for Sick Children in Toronto. The
first images were received with great enthusiasm. More recently, newer equipment
with faster scan times and better resolution has enabled us to delineate disease
processes with even greater accuracy. In the past 9 years we have performed more
than 5000 body scans in children. With this experience our examination techniques
have changed and the indications for CT in children have been modified. CT has
come to occupy an important and specific place in the management of pediatric
patients. The performance of body CT studies in children is not always easy.
Excellent diagnostic studies can be obtained only with a special understanding of the
problems of pediatric patients and pediatric pathology. The information contained
herein is a review of our experience with pediatric body CT, how we use body CT in
children, and its relationship to other modalities in this department.
This book illustrates the CT appearances of the normal anatomy and the common
as well as the rare pathological entities involving the chest, abdomen, pelvis, neck,
and musculoskeletal system in children. In the Radiology Department at the Hospi
tal for Sick Children in Toronto, CT studies of the head, face, and spinal cord are
supervised by our pediatric neuroradiologists. These areas have thus been excluded
from consideration. For a detailed account of the use of CT metrizamide myel
ography in children, the reader is referred to CT and Myelography of the Spine and Cord,
authored by Drs. Holger Pettersson and Derek Harwood-Nash, which deals
extremely well with our departmental approach to CT ot the spine in children.
However, the relationship of CT metrizamide myelography to general body CT
studies is described in the present book in the sections dealing with paras pinal and
vertebral lesions.
Most of the illustrations are from studies performed with the General Electric 9800
(2-s scanner) and 8800 (4.8-, 5.7-, 9.6-s scanner) CT machines and thus reflect
imaging with state of the art equipment. A few illustrations are from studies
performed with our original Ohio Nuclear Delta 50 scanner (2-min scan time). The
reason for including these old images is either that they illustrate rare conditions that
we have not had the opportunity to study on our newer scanners at the Hospital for
Sick Children, or because at that time CT was used more commonly to delineate
certain entities that are now better delineated with other less expensive modalities.
The information contained in this book will be of vital interest not only to all
viii Preface
pediatric radiologists, but also to adult radiologists who are involved with perform
ing body CT examinations in children, as well as to pediatricians, pediatric oncolo
gists and radiotherapists, pediatric general surgeons, thoracic surgeons, and
orthopedic surgeons. It is hoped that the information provided will be of assistance
to these groups of physicians, will help others in making accurate diagnoses, and
will aid in the efficient management of pediatric patients.
At the time of writing, the use of nuclear magnetic resonance scanning in children
is still in its infancy. The role of nuclear magnetic resonance and its relationship to
body CT in the pediatric age group have thus yet to be defined and will require
continuing critical reassessment of our use of CT. It is hoped, however, that the
information set forth will lay a foundation for the understanding of the cross
sectional images also obtained with nuclear magnetic resonance.
Acknowledgements
I would like to express my gratitude to the following people:
Dr. David Martin (presently at the Ottawa Children's Hospital) and Dr. Gordon
Culham (presently at the Vancouver Children's Hospital), who taught me the uses
and technique of body CT in children. Their hours of teaching and encouragement
laid the foundations for this book.
My radiological colleagues, including Drs. David Martin, Gordon Culham, Bernard
Reilly, and David Stringer, who have taken part in body CT studies in the Radiology
Department of the Hospital for Sick Children, Toronto, in the past and at present, for
their advice and professional contributions.
Dr. Derek Harwood-Nash, Radiologist-in-chief, the Hospital for Sick Children,
Toronto, for his constant encouragement, advice, and enthusiasm.
Dr. Charles Fitz, former Head, Division of Special Procedures, for his cooperation
and advice.
Dr. Helen Chan, Division of Hematology and Oncology, Department of Pediatrics,
for her enthusiasm, advice, and endless hours of work in obtaining clinical infor
mation on the patients reported in our previous papers and in this book.
The technical and nursing staff in the Radiology Department, whose valuable
expertise plays an important role in the continuing performance of high-quality
body CT examinations in this institution.
The secretaries, in particular Lori Fearon, Julete Harris, and Gladys Clarke for their
hours toiling over the manuscript so efficiently and also more recently Karen
Fennell.
The photographic personnel in the Department of Visual Education, for their exper
tise and cooperation.
The past and present Fellows of our department who have helped in the perform
ance of body CT studies and who have also taken part in the numerous projects that
have been published and presented at radiological meetings, in particular Veronica
Donoghue, Chris Farrelly, Peter Liu, Geoff Robey, Piyoosh Kotecha and Alan
Sprigg.
Lastly, and most important of all, I would like to thank my wife and daughters for
still accepting me as part of the family during the preparation of this book.
Ontario, February 1986 Alan Daneman
Contents
SECTION I: INTRODUCTION
Chapter 1 General Considerations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Factors Affecting Choice of Modality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
GeneralCon~derations ............................................ 6
Clinical and Radiological Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
References .......... .' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Chapter2 Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Prescan Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Patient Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Instructions and Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Sedation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Immobilization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Contrast Administration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Scan Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Computed Radiographs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Axial Scans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Posts can Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Guidance Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Summary............................................................ 17
x Contents
SECTION II: CHEST
Chapter3 Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Window Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Pseudomasses and Anatomical Variations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 23
Bones............... .......... .................... ..... ..... ..... 23
Vessels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Chapter4 Mediastinum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Anatomical Compartments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Thymus.............................................................. 27
Trachea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Heart and Pericardium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 34
Mediastinal Masses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Anterior Mediastinum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 36
Middle Mediastinum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 42
Posterior Mediastinum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Other Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 48
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 52
Chapter 5 Lung Parenchyma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 55
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Diffuse Parenchymal Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Mass Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Pulmonary Nodules. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 60
Accuracy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Appearances. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 61
Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 63
Differentiation from Vessels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 65
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 67
Chapter 6 Chest Wall and Pleura. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 69
Superficial Soft Tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
BonyThorax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Extrapleural Tissues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Pleura. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Postradiation Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 82
SECTION III: ABDOMEN
Chapter7 Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Gastrointestinal Contrast Material. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Contents xi
Intravenous Contrast Material. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 86
Scan Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Chapter 8 Retroperitoneum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Anatomy............................................................. 89
Pathology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
LymphNodes............................................ ..... .... 95
Neoplasms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 98
Sympathetic Nervous System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 100
Soft Tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 100
Blood Vessels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 103
NonpalpableTestis ................................................ 104
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 104
Chapter 9 Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 107
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 107
Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 107
Relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 109
Size ................................. ',' . . . . . . . . . . . . . . . . . . . . . . . . . .. 109
Displacements. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 112
Pathology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 112
Pancreatitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 112
Trauma ........................................................... 112
Neoplasms ........................................................ 116
Cystic Fibrosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 118
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 120
ChapterlO Adrenals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 121
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 121
Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 121
Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 122
Shape and Relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 122
Size. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 122
Hyperplasia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 123
Pseudotumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 123
Neoplasms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 125
Medullary and Sympathetic Nervous System Lesions. . . . . . . . . . . . . . . . .. 126
Adrenocortical Neoplasms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 137
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 141
AdrenalHemorrhage .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 141
Adrenal Calcification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 141
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 141
Chapter 11 Kidneys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 145
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 145
Indications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 145
Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 146
Anatomy ............................................................. 147
Normal Variants and Congenital Anomalies. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 148
xii Contents
Pathology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 148
Cysts ............................................................. 148
Renal Vein Thrombosis ............................................. 151
Attenuation Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 151
Inflammation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 152
Neoplasia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 153
Trauma ........................................................... 169
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 170
Chapter12 Liver. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 173
Introduction .......................................................... 173
Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 173
Surfaces. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 173
Attenuation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 173
Vessels ........................................................... 174
Lobes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 174
Pathology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 174
Diffuse Parenchymal Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 174
Portal Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 179
Masses ........................................................... 180
Trauma ........................................................... 193
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 196
Chapter 13 Biliary Tract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 197
Introduction .......................................................... 197
Anatomy ............................................................. 197
Gallbladder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 197
Bile Ducts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 198
Pathology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 201
Gallbladder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 201
Bile Ducts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 203
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 207
Chapter14 Spleen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 209
Introduction .......................................................... 209
Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 209
Size .................................................................. 209
Normal Variations and Congenital Anomalies. . . . . . . . . . . . . . . . . . . . . . . . . . .. 210
Shape ............................................................ 210
Position. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 212
Displacements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 214
Attenuation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 216
Pathology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 217
Neoplasms ........................................................ 217
Cysts ............................................................. 218
Trauma ........................................................... 219
Asplenia/Polysplenia Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 219
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 219