Problem Solving in Abdominal Imaging

735 Pages·2009·139.92 MB·English

by  Neal C. Dalrymple MD

1600 John F. Kennedy Blvd.
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PROBLEM SOLVING IN ABDOMINAL IMAGING ISBN: 978-0-323-04353-3
Copyright © 2009 by Mosby, Inc., an imprint of Elsevier Inc.
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Knowledge and best practice in this fi eld are constantly changing. As new research and
experience broaden our knowledge, changes in practice, treatment and drug therapy may
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of administration, and contraindications. It is the responsibility of the practitioner, rely-
ing on their own experience and knowledge of the patient, to make diagnoses, to deter-
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authors assume any liability for any injury and/or damage to persons or property arising
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The Publisher
Library of Congress Cataloging-in-Publication Data
Dalrymple, Neal C.
Problem solving in abdominal imaging with CD-ROM / Neal C. Dalrymple,
John R. Leyendecker, Michael Oliphant. -- 1st ed.
p. ; cm. -- (Problem solving in radiology series)
ISBN 978-0-323-04353-3
1. Abdomen--Imaging--Handbooks, manuals, etc. I. Leyendecker, John R. II. Oliphant,
Michael, 1941- III. Title. IV. Series: Problem solving in radiology.
[DNLM: 1. Radiography, Abdominal--methods. 2. Diagnostic Imaging--methods. WI 900
D151p 2010]
RC944.D35 2010
617.5’507572--dc22
2008049004
Acquisitions Editor: Rebecca Gaertner
Editorial Assistant: Elizabeth Hart
Project Manager: David Saltzberg
Design Director: Steve Stave
Marketing Manager: Nancy Ciliberti
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
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To my wife, Monika, and to my daughter, Alexandra, for their steadfast patience,
love, and support
NCD
To Mary, Michael, and Bridget for their love and support
JRL
To Phyllis—All my love always
MO
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Contributors
Matthew Blurton, MD Neal C. Dalrymple, MD
Radiology Department Associate Professor of Radiology
Singleton Associates, PA The University of Texas Health Science Center
Houston, Texas at San Antonio
22: Percutaneous Biopsy and Drainage San Antonio, Texas
1: Ultrasound; 2: Multidetector Computed Tomography;
Samir A. Chhaya, MD 5: A Multidimensional Approach to Abdominal Imaging;
Assistant Professor of Radiology 7: Computed Tomography Incidentalomas; 8: Imaging Evaluation of
Musculoskeletal Radiology Section Acute Abdominal Pain; 9: Imaging Evaluation of Trauma;
The University of Texas Health Science Center 17: Adrenal Glands; 18: Kidneys; 19: Ureters, Bladder, and
at San Antonio Urethra; 20: Male Reproductive System; 21: Female Reproductive
San Antonio, Texas System; 25: Survival Guide to Findings in the Lower Chest;
26: Survival Guide to Bone Findings in the Abdomen 26: Survival Guide to Bone Findings in the Abdomen and Pelvis
and Pelvis
Andrew Deibler, MD
David Childs, MD Resident, Diagnostic Radiology
Assistant Professor of Radiology Department of Radiology
Abdominal Imaging Section Wake Forest University School of Medicine
Wake Forest University School of Medicine Winston-Salem, North Carolina
Winston-Salem, North Carolina 11: Common Inherited and Metabolic Disorders
21: Female Reproductive System
David J. DiSantis, MD, MS
Paige Clark, MD Associate Professor
Assistant Professor Department of Radiology
Department of Radiology Wake Forest University School of Medicine
Wake Forest University School of Medicine Winston-Salem, North Carolina
Winston-Salem, North Carolina 16: Gastrointestinal Tract
4: Positron Emission Tomography
Constanza J. Gutierrez, MD
Monika Dalrymple, MD Assistant Professor of Radiology
Staff Radiologist Cardiothoracic Radiology Section
South Texas Radiology Group The University of Texas Health Science Center
San Antonio, Texas at San Antonio
25: Survival Guide to Findings in the Lower Chest San Antonio, Texas
25: Survival Guide to Findings in the Lower Chest
vii
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viii CONTRIBUTORS
Adam J. Jung, MD Phil Ralls, MD
Resident, Diagnostic Radiology Professor, Department of Radiology
Graduate Student in Radiological Sciences Keck School of Medicine
The University of Texas Health Science Center University of Southern California
at San Antonio Los Angeles, California
San Antonio, Texas 1: Ultrasound
20: Male Reproductive System
Hisham Tchelepi, MD
John R. Leyendecker, MD Instructor of Radiology
Associate Professor of Radiology Department of Radiology
Department of Radiology Keck School of Medicine
Wake Forest University School of Medicine University of Southern California
Winston-Salem, North Carolina Los Angeles, California
3: Magnetic Resonance Imaging; 6: Localization and Spread of 1: Ultrasound; 13: Gallbladder and Bile Ducts;
Disease; 7: Computed Tomography Incidentalomas; 8: Imaging 23: Lesion Composition
Evaluation of Acute Abdominal Pain; 10: A Brief Guide to Cancer
Imaging; 11: Common Inherited and Metabolic Disorders; 12: Anthony I. Zarka, MD
Liver; 13: Gallbladder and Bile Ducts; 14: Pancreas; 15: Spleen; Staff Radiologist
16: Gastrointestinal Tract; 22: Percutaneous Biopsy and Drainage; Wilford Hall Medical Center
23: Lesion Composition; 24: Atlas of Basic Surgical Procedures Lackland Air Force Base, Texas
20: Male Reproductive System
Michael Oliphant, MD, FACR
Professor of Radiology
Wake Forest University School of Medicine
Winston-Salem, North Carolina
6: Localization and Spread of Disease; 8: Imaging Evaluation
of Acute Abdominal Pain; 9: Imaging Evaluation of Trauma;
10: A Brief Guide to Cancer Imaging; 14: Pancreas; 16: Gastroin-
testinal Tract
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Foreword
The fi eld of abdominal imaging is quite broad, having thereby allowing his or her diagnostic skills to mature.
implications for a variety of imaging specialists. This is Maturity yields diagnoses that are more specifi c with
primarily because of the abdomen’s central location superior handling of tough and challenging cases. Lastly,
within the body, because it is a frequent focus of emer- a fellowship may provide expertise in certain interven-
gent conditions, and because it includes several differ- tional techniques.
ent organs and their associated disease processes. How will this book help one approximate fellowship
Ideally, all radiologists who are responsible for the in- training in abdominal imaging? While it won’t give you
terpretation of images in the abdomen and pelvis experience performing interventional procedures, it will
should acquire subspecialty training in abdominal im- defi nitely provide a handy resource that focuses on the
aging. This notion, of course, is neither practical nor anatomy and disease processes in the abdomen and
realistic. Alternatively, one can attempt to acquire some pelvis, familiarize you with the issues related to proto-
level of expertise from continuing medical educational col design, aid in the development of multi-modality
endeavors, such as attending meetings or viewing on- organ-oriented diagnostic algorithms, and expose you
line content. While these formats are indeed informa- to a large variety of interesting and challenging cases. If
tive, they may not be well suited to one’s particular pace, the end result is a mature diagnostician, then the in-
area of interest, or clinical need. This book provides an tended purpose of the book can be considered sound.
excellent solution to this problem, particularly in the The editors of this book, Drs. John Leyendecker, Neal
way that the material is presented. Dalrymple, and Michael Oliphant, are noted experts in
In a way, this publication is like a “fellowship in a the fi eld of abdominal imaging and are well suited to
book.” Having said that, it might be prudent to ask, teaching the principles emphasized in this new and ex-
“What exactly does one receive from fellowship subspe- citing book. On a personal note, I am particularly hon-
cialty training?” First, a fellowship allows the individual ored and delighted to have been invited to write the
to concentrate or focus his or her efforts on a specifi c Foreword for this book, as John Leyendecker and I
group of anatomic and disease processes. Second, a fel- worked together years ago when he was a resident in
lowship allows the individual to become familiar with Diagnostic Radiology at Emory University. It was obvi-
the design and implementation of imaging protocols, ous to me and the other faculty back then that John was
particularly in CT, MRI, and PET. Third, a fellowship a unique and special radiologist, destined to make a dif-
gives the individual ample opportunities to develop di- ference in our specialty. His work ethic and attention to
agnostic algorithms relative to a multi-modality organ- detail are attributes that have made him an outstanding
oriented approach. Fourth, a fellowship exposes the editor of the material presented in this exceptional
individual to a high volume and wide variety of cases, book.
Rendon C. Nelson, MD
Reed and Martha Rice Distinguished Professor of Radiology
Division of Abdominal Imaging
Duke University
ix
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