Internal Medicine: An Illustrated Radiological Guide

597 Pages·2017·58.87 MB·English

by  Jarrah Ali Al-Tubaikh (auth.)

Jarrah Ali Al-Tubaikh
Internal Medicine
An Illustrated
Radiological Guide
Second Edition
123
I nternal Medicine
J arrah A li A l-Tubaikh
I nternal Medicine
An Illustrated Radiological Guide
Second Edition
J arrah A li A l-Tubaikh
D epartment of Clinical Radiology
A miri Hospital – Kuwait City
K uwait City, K uwait
All illustrations marked with were drawn by the author.
I SBN 978-3-319-39746-7 ISBN 978-3-319-39747-4 (eBook)
DOI 10.1007/978-3-319-39747-4
L ibrary of Congress Control Number: 2016954639
© Springer International Publishing Switzerland 2 017
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P rinted on acid-free paper
T his Springer imprint is published by Springer Nature
T he registered company is Springer International Publishing AG Switzerland
V
P refa ce
It is a privilege to write another introduction to investigate certain diseases. In the same fashion,
this book. When I wrote this book in Munich in many radiologists are pleased with the variety of
2010, I knew I was writing a book with an uncom- images that detail the medical disorders and facili-
mon combination, linking internal medicine to tate their detection.
radiology. I can still remember the comment of my
mentor Prof. Maximillian Reiser af er he saw the Based on the past positive feedbacks, I aimed to
manuscript’s content. He told me: “Why did you expand the range of the book by including three
choose this layout and these disorders in particu- more medical f elds, which are not directly linked
lar?” I replied: “T ey are the most commonly to internal medicine but however are important to
encountered diseases daily in any busy medical know. T e second edition of this book exposes the
department.” reader to occupational medicine and toxicology,
which are uncommonly seen as cases of attempt-
Over the years, I have noticed how the chapter’s ing suicide and accidental intoxications. T e
download numbers are increasing in Springer’s radiological literature is f lled with dif erent radio-
of cial website. T is ref ects, to me at least, the con- logical signs reported by many researches detailing
tinuous demand for such topics worldwide, espe- intoxications, which have become of great interest
cially among newly coming radiologists. T ey are since the data are accumulating over the years.
the ones facing the f re daily in duties and emer-
gency calls from physicians and surgeons around C hiropractic and osteopathic medicine are two
the clock. Moreover, radiology board teachings important f elds that emerged more than a hun-
concentrate more and more over emergency cases, dred years ago, and they are rarely, if ever, men-
trauma cases, postoperative complications, and tioned or taught in medical schools or
cancer screening and monitoring. I can assure you board-certif cation programs, especially in spe-
that almost 90 % of any radiologist’s daily routine cialties related to the orthopedics or the spine.
lies within one or more of the past four areas in Although they are not considered part of conven-
radiology. Internal medicine disorders and com- tional medicine, both specialties have very solid
plications are considered extracurriculum, and neuroanatomical and neuropathophysiological
maybe special interest radiology. basis. Chiropractic medicine in particular, founded
by D. D. Palmar and perfected by B. J. Palmar, uses
W ithin the past 5 years since the publication of radiology as an essential part of its diagnostic tech-
this book, I have noticed a skyrocketing increase in niques. T eir radiographic imaging techniques are
the radiological referrals through my work in two known as “spinography.” Personally, I have been
dif erent hospitals. Sometimes, we get radiological using their radiographic techniques in an exten-
referral for simple disorders that do not need sive fashion to diagnose lower back pain and kine-
radiological investigation, for example, more and siological disorders. T eir radiological imaging
more demands for ultrasound to exclude inguinal techniques proved to be very valid and very accu-
hernias, ultrasound for lipoma, CT for acute rate in diagnosing lower back pain, especially lum-
appendicitis suspicion, polytrauma PAN- CT, etc. bar spine MRI with almost normal f ndings.
As a radiologist, it is always nice to be needed; Unfortunately, such radiological knowledge is very
however, technology can be a double-e dged sword, rarely encountered in commonly known radiolog-
reducing the clinical experience of both the refer- ical journals. I sincerely hope that the reader will
ring clinician and the radiologist. Many physicians, f nd the chapter of chiropractic medicine imaging
unfortunately, started to use radiology as a substi- interesting and informative.
tute for clinical examination and judgment.
Although such a phenomenon is not necessarily L astly, a very new medical specialty is arising
widely found, it is there, no doubt about it. within the past 5 years: energy and quantum med-
icine. Although it started with the book W hat Is
I am pleased that the f rst edition of my book has Life? (1944) by the Nobel Prize winner Austrian
helped many physicians I know to change their physicist Erwin Schrödinger, many new medical
perspective toward radiological investigations. I and biological researchers are now using quantum
have been contacted by many physicians here in physics to def ne life, including Robert O. Becker,
Kuwait and outside of Kuwait who thank me for Jerry Tennant, Hans-Peter Dürr, Fritz-Albert
detailing what they should order and how to Popp, Mae-Wan Ho, and so many others. T eir
VI Preface
works have now evolved to so many applications, publishing the second edition of this book to
emerging as unconventional therapies that use introduce the reader to a whole new world that
waves and frequencies to heal, such as pulsed elec- uses therapies based on biophysics rather than bio-
tromagnetic f eld (PEMF) therapy, microcurrent chemistry for conventional, pharmacological
therapy, phototherapy, and ultrasonic therapy. I medicine uses.
have been personally using these devices for myself
and my relatives and for special cases in the hospi- In conclusion, I hope for the reader an interesting
tal, with a high success rate of controlling diseases journey through the book, and I hope that this
and complications. I documented my f ndings on book can help someone somewhere in the world
radiological images, imaging patients before and save a life.
af er such unconventional, energetic therapy to
f nd out what has been changed in the disease sta- J arrah A li A l-Tubaikh, M D
tus radiographically. I took the opportunity of K uwait City, Kuwait
VII
C ontents
1 G astroenterology ............................................................................................................................................................ 1
1 .1 Liver Cirrhosis......................................................................................................................................................................... 2
Types of Liver Cirrhosis ......................................................................................................................................................... 2
1 .2 Fatty Liver Disease (Liver Steatosis) ............................................................................................................................. 1 5
Types of Liver Steatosis ......................................................................................................................................................... 1 5
1 .3 Recurrent Epigastric Pain .................................................................................................................................................. 1 7
Gastroesophageal Refl ux Disease ..................................................................................................................................... 1 7
Diff erential Diagnoses and Related Diseases ................................................................................................................. 1 8
Peptic Ulcer Disease ............................................................................................................................................................... 2 4
Superior Mesenteric Artery Syndrome (Wilkie’s Syndrome) ..................................................................................... 2 7
Median Arcuate Ligament Syndrome (Celiac Trunk Compression Syndrome/Dunbar’s Syndrome) ........... 29
Recurrent Abdominal Pain of Childhood ........................................................................................................................ 2 9
1 .4 Infl ammatory Bowel Diseases ......................................................................................................................................... 3 0
Crohn’s Disease ........................................................................................................................................................................ 3 1
Extraintestinal Manifestations of CD ................................................................................................................................ 3 1
Ulcerative Colitis ..................................................................................................................................................................... 3 6
Extraintestinal Manifestations of UC ................................................................................................................................ 3 6
Diff erences Between Ulcerative Colitis and Crohn’s Disease .................................................................................... 3 9
Diff erential Diagnoses and Related Diseases ................................................................................................................. 3 9
1 .5 Gastrointestinal Hemorrhage ......................................................................................................................................... 4 0
1 .6 Pancreatitis .............................................................................................................................................................................. 4 1
Acute Pancreatitis ................................................................................................................................................................... 4 1
Diff erential Diagnoses and Related Diseases ................................................................................................................. 4 1
Chronic Pancreatitis ............................................................................................................................................................... 4 5
1 .7 Jaundice .................................................................................................................................................................................... 4 8
Kernicterus ................................................................................................................................................................................ 5 0
Obstructive Jaundice ............................................................................................................................................................. 5 0
Bile Plug Syndrome ................................................................................................................................................................ 5 2
Infectious Ascending Cholangitis ...................................................................................................................................... 5 2
Choledochal Web .................................................................................................................................................................... 5 3
1 .8 Diarrhea and Malabsorption ........................................................................................................................................... 5 4
Normal Anatomy ..................................................................................................................................................................... 5 4
Pathophysiology ..................................................................................................................................................................... 5 4
Common Causes of Diarrhea and Their Mechanism of Action ................................................................................. 5 4
Sprue ........................................................................................................................................................................................... 5 5
Whipple’s Disease (Intestinal Lipodystrophy) ................................................................................................................ 5 6
VIPoma (Werner–Morris Syndrome/Pancreatic Cholera) ........................................................................................... 5 7
2 N eurology ............................................................................................................................................................................ 59
2 .1 Stroke (Brain Infarction) .................................................................................................................................................... 6 2
Diff erential Diagnoses and Related Diseases ................................................................................................................. 6 2
2 .2 Stroke Diseases and Syndromes .................................................................................................................................... 6 6
Moyamoya Disease (Progressive Occlusive Arteritis) .................................................................................................. 6 6
Cerebral Amyloid Angiopathy ............................................................................................................................................ 6 8
CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts
and Leukodystrophy) ............................................................................................................................................................. 6 9
MELAS (Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes) ................. 7 0
Cortical Laminar Necrosis ..................................................................................................................................................... 7 1
Man-in-the-Barrel Syndrome .............................................................................................................................................. 7 2
Locked-In Syndrome .............................................................................................................................................................. 7 3
Brain Stem Infarction Syndromes ...................................................................................................................................... 7 3
Subclavian Steal Syndrome ................................................................................................................................................. 7 5
VIII Contents
2 .3 Intracranial Hemorrhage ................................................................................................................................................... 7 6
Epidural Hematoma ............................................................................................................................................................... 7 7
Subdural Hematoma .............................................................................................................................................................. 7 8
Subarachnoid Hemorrhage ................................................................................................................................................. 7 9
Intracerebral/Intraparenchymal Hemorrhage ............................................................................................................... 8 0
Intraventricular Hemorrhage .............................................................................................................................................. 8 1
Hemorrhage into Malignancy ............................................................................................................................................. 8 2
2 .4 Meningitis ................................................................................................................................................................................ 8 2
Diff erential Diagnoses and Related Diseases ................................................................................................................. 8 4
2 .5 Encephalitis ............................................................................................................................................................................. 8 5
Limbic Encephalitis ................................................................................................................................................................ 8 5
Acute Demyelinating Encephalomyelitis (ADEM) ........................................................................................................ 8 7
Hashimoto’s Encephalitis...................................................................................................................................................... 8 8
Rasmussen Encephalitis (Rasmussen Syndrome) ......................................................................................................... 8 9
Measles Encephalitis .............................................................................................................................................................. 8 9
Subacute Sclerosing Panencephalitis (SSPE) ................................................................................................................. 9 0
Japanese Encephalitis ........................................................................................................................................................... 9 0
West Nile Encephalitis ........................................................................................................................................................... 9 0
Tick-Borne Encephalitis (Spring–Summer Encephalitis) ............................................................................................ 9 0
Murray Valley Encephalitis ................................................................................................................................................... 9 1
St. Louis Encephalitis ............................................................................................................................................................. 9 1
Encephalitis Lethargica ......................................................................................................................................................... 9 1
2 .6 Epilepsy ..................................................................................................................................................................................... 9 2
Diff erential Diagnoses and Related Diseases ................................................................................................................. 9 3
2 .7 Headache ................................................................................................................................................................................. 9 6
Migraine ..................................................................................................................................................................................... 9 6
Spontaneous Intracranial Hypotension (Schaltenbrand Syndrome) ..................................................................... 9 7
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) .................................................................................. 9 7
Temporal (Giant) Cell Arteritis ............................................................................................................................................ 9 8
2 .8 Multiple Sclerosis and Other Demyelinating Diseases ........................................................................................ 9 9
Multiple Sclerosis .................................................................................................................................................................... 9 9
Neuromyelitis Optica (Devic’s Syndrome) ...................................................................................................................... 1 01
Marburg’s Type MS ................................................................................................................................................................. 1 02
Baló Concentric Sclerosis ..................................................................................................................................................... 1 03
Schilder’s Disease (Diff use Myelinoclastic Sclerosis) ................................................................................................... 1 03
Susac’s Syndrome ................................................................................................................................................................... 1 03
Guillain–Barré Syndrome ..................................................................................................................................................... 1 04
2 .9 Parkinsonism .......................................................................................................................................................................... 1 06
Diff erential Diagnoses and Related Diseases ................................................................................................................. 1 07
2 .10 Dementia .................................................................................................................................................................................. 1 08
Alzheimer’s Disease ................................................................................................................................................................ 1 08
Vascular Dementia .................................................................................................................................................................. 1 09
Frontotemporal Lobar Degeneration (Pick’s Disease) ................................................................................................. 1 09
Dementia with Lewy Bodies ................................................................................................................................................ 1 11
Progressive Supranuclear Palsy (Steele–Richardson–Olszewski Syndrome) ....................................................... 1 11
Multiple System Atrophy (Shy–Drager Syndrome) ...................................................................................................... 1 12
Subcortical Arteriosclerotic Encephalopathy (Binswanger’s Disease) ................................................................... 1 13
Prion Disease ............................................................................................................................................................................ 1 14
2 .11 Huntington’s Disease .......................................................................................................................................................... 1 16
Diff erential Diagnoses and Related Diseases ................................................................................................................. 1 17
2 .12 Heat Stroke (Pancerebellar Syndrome) ....................................................................................................................... 1 17
2 .13 Aphasia ..................................................................................................................................................................................... 1 17
Neural Control of Speech ..................................................................................................................................................... 1 18
Aphasia Pathophysiology and Subtypes ......................................................................................................................... 1 18
2 .14 Squint (Strabismus) ............................................................................................................................................................. 1 22
Neural Control of Ocular Muscles ...................................................................................................................................... 1 22
Pathophysiology ..................................................................................................................................................................... 1 22
Related Disorders .................................................................................................................................................................... 1 22
IX
Contents
2 .15 Nystagmus ............................................................................................................................................................................... 1 24
Neural Control of Eye Movement ...................................................................................................................................... 1 24
Nystagmus Subtypes ............................................................................................................................................................. 1 25
2 .16 Erectile Dysfunction ............................................................................................................................................................ 1 26
Neural Control Human Sexual Behavior .......................................................................................................................... 1 26
Pathophysiology ..................................................................................................................................................................... 1 27
Erectile Dysfunction Diff erential Diagnoses................................................................................................................... 1 27
3 E ndocrinology and Metabolism ............................................................................................................................ 1 31
3 .1 Graves’ Disease (Hyperthyroidism) ............................................................................................................................... 1 32
3 .2 Hyperparathyroidism ......................................................................................................................................................... 1 33
Diff erential Diagnoses and Related Diseases ................................................................................................................. 1 34
3 .3 Growth Hormone Diseases ............................................................................................................................................... 1 38
Growth Hormone Insuffi ciency (Hypopituitarism)....................................................................................................... 1 39
Acromegaly and Gigantism ................................................................................................................................................. 1 40
Growth Hormone Insensitivity (Laron Syndrome) ....................................................................................................... 1 43
Carney’s Complex ................................................................................................................................................................... 1 43
3 .4 Osteoporosis ........................................................................................................................................................................... 1 45
Primary Osteoporosis ............................................................................................................................................................ 1 45
Secondary Osteoporosis ....................................................................................................................................................... 1 48
Regional Migratory Osteoporosis of the Hip (Bone Marrow Edema Syndrome) ................................................ 1 48
3 .5 Rickets and Osteomalacia ................................................................................................................................................. 1 49
Diff erential Diagnoses and Related Diseases ................................................................................................................. 1 50
3 .6 Scurvy ........................................................................................................................................................................................ 1 52
3 .7 Fluorosis ................................................................................................................................................................................... 1 54
3 .8 Lead Poisoning (Plumbism) ............................................................................................................................................. 1 56
3 .9 Adrenal Glands Abnormalities ....................................................................................................................................... 1 57
Cushing’s Syndrome ............................................................................................................................................................... 1 57
Conn’s Syndrome (Hyperaldosteronism) ......................................................................................................................... 1 58
Addison’s Disease.................................................................................................................................................................... 1 59
Pheochromocytoma .............................................................................................................................................................. 1 60
Neuroblastoma ........................................................................................................................................................................ 1 61
X-Linked Adrenoleukodystrophy ....................................................................................................................................... 1 61
Testicular Adrenal Rest Tumors .......................................................................................................................................... 1 62
3 .10 Sex Hormone Abnormalities ........................................................................................................................................... 1 62
Polycystic Ovary Disease (Stein–Leventhal Syndrome) .............................................................................................. 1 63
Precocious Puberty ................................................................................................................................................................ 1 63
Van Wyk and Grumbach Syndrome .................................................................................................................................. 1 64
Gynecomastia .......................................................................................................................................................................... 1 65
Intersex Disorders ................................................................................................................................................................... 1 66
Diff erential Diagnoses and Related Diseases ................................................................................................................. 1 68
3 .11 Sheehan Syndrome (Postpartum Hypopituitarism) ............................................................................................. 1 70
4 N ephrology ......................................................................................................................................................................... 1 73
4 .1 Hypertension .......................................................................................................................................................................... 1 74
Renal Artery Stenosis ............................................................................................................................................................. 1 74
Coarctation of the Aorta ....................................................................................................................................................... 1 78
Polyarteritis Nodosa ............................................................................................................................................................... 1 79
Takayasu Arteritis .................................................................................................................................................................... 1 80
Midaortic Syndrome .............................................................................................................................................................. 1 81
Preeclampsia ............................................................................................................................................................................ 1 81
Reversible Posterior Leukoencephalopathy Syndrome (Hypertensive
Encephalopathy) ..................................................................................................................................................................... 1 82
Nephroptosis (Floating Kidney) ......................................................................................................................................... 1 83
Riley–Day Syndrome (Familial Dysautonomia) ............................................................................................................. 1 83
Stafne’s Bone Defect of the Mandible .............................................................................................................................. 1 83
Hypertensive Heart Disease ................................................................................................................................................ 1 83
X Contents
4 .2 Polycystic Kidney Disease ................................................................................................................................................. 1 85
Autosomal Dominant Polycystic Kidney Disease ......................................................................................................... 1 85
Autosomal Recessive Polycystic Kidney Disease .......................................................................................................... 1 86
Acquired Polycystic Kidney Disease.................................................................................................................................. 1 87
Diff erential Diagnoses and Related Diseases ................................................................................................................. 1 88
4 .3 Renal Failure ........................................................................................................................................................................... 1 88
Examples of Renal Parenchymal Disorders According to Their Anatomical Involvement ............................... 1 88
5 C ardiology ........................................................................................................................................................................... 1 93
5 .1 Acute Chest Pain ................................................................................................................................................................... 1 94
Acute Coronary Syndrome ................................................................................................................................................... 1 94
Acute Pulmonary Embolism ................................................................................................................................................ 1 97
Aortic Dissection ..................................................................................................................................................................... 1 99
Aortic Intramural Hematoma .............................................................................................................................................. 2 01
Penetrating Atherosclerotic Ulcer ..................................................................................................................................... 2 02
5 .2 Diseases of the Great Vessels .......................................................................................................................................... 2 02
Thoracic Aortic Aneurysm .................................................................................................................................................... 2 02
Pulmonary Hypertension ..................................................................................................................................................... 2 03
Coral Reef Aorta ...................................................................................................................................................................... 2 05
Superior Vena Cava Syndrome ........................................................................................................................................... 2 05
5 .3 Myocardial Diseases (Cardiomyopathies) .................................................................................................................. 2 06
Hypertrophic Cardiomyopathy .......................................................................................................................................... 2 06
Dilated Cardiomyopathy ...................................................................................................................................................... 2 08
Restrictive Cardiomyopathy ................................................................................................................................................ 2 08
Arrhythmogenic Right Ventricular Dysplasia ................................................................................................................. 2 08
Noncompaction Cardiomyopathy (Spongy Myocardium) ........................................................................................ 2 09
Peripartum Cardiomyopathy (Cardiomyopathy of Pregnancy) ............................................................................... 2 10
5 .4 Endocarditis ............................................................................................................................................................................ 2 10
Infective Endocarditis ............................................................................................................................................................ 2 11
Löffl er’s Endocarditis (Eosinophilic Endomyocardial Disease) ................................................................................. 2 13
Marantic Endocarditis (Nonbacterial Thrombotic Endocarditis) ............................................................................. 2 14
5 .5 Pericardial Diseases ............................................................................................................................................................. 2 15
Diff erential Diagnoses and Related Diseases ................................................................................................................. 2 15
6 R heumatology ................................................................................................................................................................... 2 19
6 .1 Rheumatoid Arthritis .......................................................................................................................................................... 2 20
Diff erential Diagnoses and Related Diseases ................................................................................................................. 2 20
6 .2 Ankylosing Spondylitis (Marie–Strümpell Disease) .............................................................................................. 2 28
Diff erential Diagnoses and Related Diseases ................................................................................................................. 2 31
6 .3 Gout Arthritis ......................................................................................................................................................................... 2 32
Diff erential Diagnoses and Related Diseases ................................................................................................................. 2 33
6 .4 CPPD and HADD .................................................................................................................................................................... 2 34
Calcium Pyrophosphate Dihydrate Crystal Deposition Disease .............................................................................. 2 34
Hydroxyapatite Crystal Deposition Disease ................................................................................................................... 2 35
6 .5 Osteoarthritis ......................................................................................................................................................................... 2 37
6 .6 Psoriasis and Psoriatic Arthritis ...................................................................................................................................... 2 41
Diff erential Diagnoses and Related Diseases ................................................................................................................. 2 41
6 .7 Baastrup’s Disease (Spinout Process Impingement Syndrome) ...................................................................... 2 44
6 .8 Scheuermann’s Disease (Juvenile Kyphosis Dorsalis)........................................................................................... 2 46
Criteria for Scheuermann’s Disease Diagnosis ............................................................................................................... 2 47
6 .9 Sjögren Syndrome (Myoepithelial Sialadenitis) ..................................................................................................... 2 49
Criteria to Diagnose SS Include .......................................................................................................................................... 2 49
6 .10 Behçet Disease ....................................................................................................................................................................... 2 52
Clinical Criteria to Diagnose BD Require a Combination of Three or More
of the Following Findings..................................................................................................................................................... 2 52