Table Of ContentMB
Differential Diagnosis
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The new Burgener: u H
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Improve your interpretation skills with br
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this bestselling comprehensive reference ug
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to interpreting abnormal CT findings r
Differential Diagnosis in Computed Tomography, second edition, is an invaluable reference aid D Francis A. Burgener
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in the evaluation of CT images to help confidently gain a general diagnostic impression and a ff
reasonable differential diagnosis. In contrast to disease-oriented radiology texts, this book is e Christopher Herzog
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organized by CT findings, enabling the reader to quickly match the appropriate differential e
n Steven P. Meyers
diagnosis to CT results. t
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Wolfgang Zaunbauer
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Special features of the second edition: D
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• Continuation of the successful Burgener concept: Comprehensive tables describe the imaging a
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patterns of the various diseases that may present on CT, along with other characteristically n 2nd edition
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associated imaging findings and pertinent physiopathologic, pathologic, and clinical data
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• Over 2,000 detailed, high-quality images demonstrating a wide range of common and uncommon is
CT findings i
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• Chapters organized according to anatomic regions, from the brain to the pelvis and the musculo-
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skeletal system, with new chapters on meningeal and calvarian lesions and on trauma o
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• Updated and revised sections reflecting the latest advances in CT technology and indications,
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including accurate staging of intra-articular and spinal fractures and evaluation of vascular
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diseases t
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• Extensive index systematically cross-references diseases and CT findings for optimal access d
to information T
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Recognizing the central role that CT plays in the field of modern medical imaging, this book is o
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essential for physicians who want to strengthen their diagnostic acumen and CT interpretation
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skills: radiologists in practice, residents preparing for board exams, and any other physician
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charged with understanding and interpreting CT images. h
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Francis A. Burgener, MD, is Professor of Radiology, University of Rochester Medical Center,
Rochester, New York, USA.
Christopher Herzog, MD, MBA, is Private Docent of Radiology, Munich, Germany.
Steven P. Meyers, MD, PhD, is Professor of Radiology and Neurosurgery, University of Rochester
Medical Center, Rochester, New York, USA.
Wolfgang Zaunbauer, MD, is Private Docent of Radiology, St.Gallen, Switzerland
An award-winning international medical and scientific publisher, Thieme has demonstrated its 2
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commitment to the highest standard of quality in the state-of-the-art content and presentation of all d
of its products. Thieme’s trademark blue and silver covers have become synonymous with excellence e
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in publishing. i
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ISBN 978-3-13-102542-5
www.thieme.com
Diff erential Diagnosis in
Computed Tomography
2nd edition
Francis A. Burgener, MD Steven P. Meyers, MD, PhD
Professor of Radiology Professor of Radiology and Neurosurgery
University of Rochester Medical Center University of Rochester Medical Center
Rochester, New York, USA Rochester, New York, USA
Christopher Herzog, MD, MBA Wolfgang Zaunbauer, MD
Department of Radiology Institute of Radiology
Rotkreuzklinikum Kantonsspital St. Gallen
Munich, Germany St. Gallen, Switzerland
In collaboration with:
Grégory Dieudonné, MD
Scott A. Mooney, MD
Richard T. White, DO
2146 illustrations
This edition includes texts and illustrations from Martti Kormano, MD, who authored
Chapters 1, 2, 10, 18, 19, 20, 21, 22, 23, 24, 25, and 26 of the fi rst edition.
Thieme
Stuttgart · New York
Library of Congress Cataloging-in-Publication Data Important note: Medicine is an ever-changing science undergo-
Burgener, Francis A., author. ing continual development. Research and clinical experience are
Diff erential diagnosis in computed tomography / Francis A. continually expanding our knowledge, in particular our knowl-
Burgener, Professor of Radiology, University of Rochester Medical
edge of proper treatment and drug therapy. Insofar as this book
Center, Rochester, New York, Steven P. Meyers, MD, PhD, P rofessor
mentions any dosage or application, readers may rest assured
of Radiology/Imaging Sciences, Neurosurgery Radiology, Resi-
that the authors, editors, and publishers have made every eff ort
dency Program Director, Director of the Fellowship in Magnetic
Resonance Imaging, University of Rochester School of Medicine to ensure that such references are in accordance with t he state
and Dentistry, Rochester, New York, Christopher H erzog, Rot- of knowledge at the time of production of the book. Neverthe-
kreuzklinikum, Radiologisches Institut, Munich, Germany, Wolf- less, this does not involve, imply, or express any guarantee or
gang Zaunbauer, Institute for Radiology, Kantonsspital St. Gallen, responsibility on the part of the publishers in respect to any
St. Gallen, Switzerland. -- Second Edition. dosage instructions and forms of applications stated in the book.
p. ; cm.
Every user is requested to examine carefully the manufacturers’
Includes bibliographical references and index.
leafl ets accompanying each drug and to check, if necessary in
I SBN 978-3-13-102542-5 (hardback)
consultation with a physician or specialist, whether the dosage
1 . Tomography. 2. Diagnosis, Diff erential. I. Meyers, Steven P.,
author. II. Herzog, Christopher, author. III. Zaunbauer, Wolfgang, schedules mentioned therein or the contraindications stated
author. IV. Title. by the manufacturers diff er from the statements made in the
[ DNLM: 1. Tomography, X-Ray Computed. 2. Diagnosis, Diff erential. present book. Such examination is particularly important with
WN 206] drugs that are either rarely used or have been newly released
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616.07′572--dc22
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2010053779
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v
Contributors
Francis A. Burgener, MD Steven P. Meyers, MD, PhD
Professor of Radiology Professor of Radiology and Neurosurgery
University of Rochester Medical Center University of Rochester Medical Center
Rochester, New York, USA Rochester, New York, USA
Christopher Herzog, MD, MBA Wolfgang Zaunbauer, MD
Institute of Radiology Institute of Radiology
Rotkreuzklinikum Kantonsspital St. Gallen
Munich, Germany St. Gallen, Switzerland
In collaboration with:
Grégory Dieudonné, MD
Assistant Professor of Radiology
University of Rochester Medical Center
Rochester, New York, USA
—Contributed Chapter 29
Scott A. Mooney, MD
Clinical Assistant Professor of Radiology
University of Rochester Medical Center
Rochester, New York, USA
—Contributed illustrations to Chapters 11, 12, 13, 14, 15, 27, 28, and 29
Richard T. White, DO
Professor of Radiology
University of Rochester Medical Center
Rochester, New York, USA
—Contributed illustrations to Chapters 27, 28, and 29
vii
Preface
Dr. Martti Kormano was my coauthor for the textbook Diff erential of the radiologist, but is also practiced and/or interpreted by a
Diagnosis in Conventional Radiology, including all subsequent large number of clinicians and surgeons. With each examina-
editions, as well as for the fi rst edition of D iff erential Diagnosis tion, one is confronted with CT fi ndings that require interpreta-
in Computed Tomography . It was a great pleasure for me to work tion in order to arrive at a general diagnostic impression and
with him on these endeavors over two decades. Unfortunately for a reasonable diff erential diagnosis. To assist the physician in
me, Dr. Kormano has since retired from his position as C hairman attaining this goal, this book is based on CT fi ndings rather than
of the Diagnostic Radiology Department of the University Hos- being disease-oriented like most other textbooks in radiology.
pital in Turku, Finland, and because of personal commitments Because many diseases present on CT in a variety of manifes-
could not fi nd the time and energy to be involved in the updating tations, some overlap in the text is unavoidable. To minimize
of this text. Because I am devoting my professional time exclu- repetition, the diff erential diagnosis of a CT fi nding is presented
sively to musculoskeletal radiology, I not only had to fi nd new in tabular form whenever feasible. Most tables not only list the
coauthors for Dr. Kormano’s section of the text, but I also needed various diseases that may present on CT in a specifi c pattern,
help for my original chapters outside of my area of main i nterest. but also describe in succinct form other characteristically as-
I was fortunate to fi nd three colleagues to completely revise sociated imaging fi ndings and pertinent clinical data. The text
Dr. K ormano’s section of the original text and update some of my is complemented by many CT images and drawings to visually
chapters. I believe Drs. Christopher Herzog, Steven P. Meyers, and demonstrate the image features under discussion.
Wolfgang Zaunbauer performed an outstanding job. I hope this revised and expanded second edition will be as
In the 15 years since the publication of the fi rst edition, the well received as the original text, which was translated into
scope of CT imaging has grown and assumed a much greater eight languages. The concept of an imaging pattern approach
role in the fi eld of medical imaging. Most of this growth is not in tabular form rather than a disease-oriented text was intro-
related to the discovery of new disease processes but, rather, it duced by Dr. Kormano and myself in 1985 with the fi rst edition
is related to the development and refi nement of CT t echnology. of D iff erential Diagnosis in Conventional Radiology and has since
The greatly improved hardware and software in CT allows been adopted by many authors. I take this as a compliment—
high- quality reconstruction images in various 2D and 3D planes, after all, imitation is the sincerest form of fl attery.
as well as dynamic examinations such as CT a ngiography and This book is meant for radiologists and physicians with some
perfusion studies. These advancements result in many new in- experience in the interpretation of CT examinations who wish
dications for CT examinations such as the accurate staging of to strengthen their diagnostic acumen. It is a comprehensive
intra-articular and spinal fractures or the evaluation of vas- outline of CT fi ndings and will be particularly useful to radiology
cular diseases. To account for this development, new sections residents preparing for their specialist examination. Any physi-
have been added to every chapter and three new chapters (3, cian involved in the interpretation of CT examination should
4, and 15) have been included in this edition—resulting in a fi nd this book helpful in direct proportion to his or her curiosity.
s ubstantial increase in both text and illustrations. Furthermore, It is my hope that the second edition of Diff erential Diagnosis in
illustrations from the fi rst edition have been updated with high- Computed Tomography will be as interesting as its predecessor
quality images. to medical students, residents, radiologists, and physicians in-
C T has gained worldwide acceptance and, in addition to many volved in the interpretation of CT images.
new indications, has also replaced conventional radiographic
techniques in many areas. CT is no longer the exclusive domain Francis A. Burgener, MD
ix
Acknowledgments
It is impossible to thank individually all those who helped to Medical Center, who authored the original Chapter 29 of this
prepare the second edition of this textbook. I wish to acknowl- text and graciously let us use this material in the new edition.
edge the staff of our publisher, in particular, Dr. Cliff ord Berg- I wish to thank Margaret Kowaluk, Sarah Peangatelli, and
man as well as Stephan Konnry and Annie Hollins, both of Katherine Tower of the Imaging Sciences graphic services sec-
whom were more recently assigned by Thieme to this project tion at the University of Rochester Medical Center for their
to deal with, among other things, my old fashioned style rely- outstanding work in preparing the illustrations. The instructive
ing primarily on paper, pencils, hard copies, and the telephone. new drawings were superbly executed by either Katherine
Their hard work, dedication, and attention to detail for this edi- Tower or Dr. Anna Zaunbauer-Womelsdorf, the daughter of one
tion are greatly appreciated. Furthermore, I am also indebted to of the coauthors of this text. Their work is greatly appreciated.
Heidi Grauel for her editorial assistance and effi cient handling Excellent secretarial support for this project was provided by
of the page proofs. Colleen Cottrell and Jill Derby for which I wish to express many
I also wish to express our gratitude to the many radiologists thanks. The general secretarial assistance of Shirley Cappiello is
who made this illustrative collection of computed tomography also greatly appreciated. Last, but not least, I am most grateful to
images available. Special thanks go to Drs. Allen Bernstein, Gary Alyce Norder who left the University and me after 30 years for
Hollenberg, Johnny Monu, Peter Rosella, Gwy Suk Seo, David the richness of the industry and subsequent partial retirement.
Shrier, Charlene Varnis, Brian Webber, Eric Weinberg, and She is, besides Jill Derby, the only person capable of deciphering
Andrea Zynda; all staff members of the University of Rochester my longhand and, as in the past, did a superb job in typing, edit-
Imaging Sciences Department; Drs. Thomas Vogl and Volkmar ing, and proofreading the manuscript of the new edition of this
Jacobi, both of the Johann Wolfgang Goethe University Clinic, text in her spare time, for which I am deeply grateful.
Frankfurt; and Drs. Tobias Hertle (Dresden), Sebastian Leschka Finally, I appreciate the support of our families who have
(Zürich), Christoph Ozdoba (Bern), Reinhand Schöpf (Landeck), forfeited precious family time for the preparation of this text.
Nikolai Stahr (Winterthur), Björn Stinn (Zürich), and Alexander Therefore, in appreciation of both their understanding and
Von Hessling (Zürich). support, my coauthors and I dedicate this book to our wives
I greatly appreciate the invaluable contribution by Dr. Patrick Therese Burgener, Christine Herzog, Barbara Weber, and
J. Fultz, Professor of Radiology at the University of Rochester Isabella Zaunbauer.
Francis A. Burgener, MD
