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Problem Solving in Abdominal Imaging PDF

735 Pages·2009·139.92 MB·English
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1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 PROBLEM SOLVING IN ABDOMINAL IMAGING ISBN: 978-0-323-04353-3 Copyright © 2009 by Mosby, Inc., an imprint of 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. Permissions may be sought directly from Elsevier’s Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333; e-mail: healthpermissions@ elsevier.com. You may also complete your request on-line via the Elsevier website at http:// www.elsevier.com/permissions. Notice 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 become necessary or appropriate. Readers are advised to check the most current informa- tion provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration 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- mine dosages and the best treatment for each individual patient, and to take all appropri- ate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors assume any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. 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 FM_i-xvi-A04353.indd iv 3/31/09 6:45:20 PM 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 FM_i-xvi-A04353.indd v 3/31/09 6:45:21 PM 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 FM_i-xvi-A04353.indd vii 3/31/09 6:45:21 PM 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 FM_i-xvi-A04353.indd viii 3/31/09 6:45:21 PM 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 FM_i-xvi-A04353.indd ix 3/31/09 6:45:21 PM

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Elsevier's new Problem Solving in Abdominal Imaging offers you a concise, practical, and instructional approach to your most common imaging questions. It presents basic principles of problem solving to apply to imaging the abdominal and pelvic organs, gastrointestinal tract, and genitourinary tract.
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