Table Of ContentInterventional Radiology
Interventional Radiology
Edited by
Hector Ferral, MD
Professor of Radiology
Section Chief, Interventional Radiology
Rush University Medical Center, Chicago
Chicago, Illinois
Jonathan Lorenz, MD
Associate Professor of Radiology
Department of Radiology
The University of Chicago
Chicago, Illinois
Series Editors
Jonathan Lorenz, MD
Associate Professor of Radiology
Department of Radiology
The University of Chicago
Chicago, Illinois
Hector Ferral, MD
Professor of Radiology
Section Chief, Interventional Radiology
Rush University Medical Center, Chicago
Chicago, Illinois
Thieme
New York • Stuttgart
Thieme Medical Publishers, Inc.
333 Seventh Ave.
New York, NY 10001
Executive Editor: Timothy Hiscock
Editorial Director: Michael Wachinger
Editorial Assistant: Adriana di Giorgio
International Production Director: Andreas Schabert
Production Editor: Heidi Grauel, Maryland Composition
Vice President, International Marketing and Sales: Cornelia Schulze
Chief Financial Offi cer: James W. Mitos
President: Brian D. Scanlan
Compositor: MPS Content Services
Printer: The Maple-Vail Book Manufacturing Group
Library of Congress Cataloging-in-Publication Data
Interventional radiology / edited by Hector Ferral, Jonathan Lorenz.
p. ; cm.―(RadCases)
Includes bibliographical references and index.
ISBN 978-1-60406-177-2
1. Interventional radiology―Case studies. I. Ferral, Hector. II. Lorenz, Jonathan. III. Series: RadCases.
[DNLM: 1. Radiography, Interventional―methods―Case Reports. 2. Diagnosis, Diff erential―Case Reports. WN 200 I61211 2010]
RD33.55.I5825 2010
617´.05―dc22
2009037652
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However, in view of the possibility of human error by the authors, editors, or publisher of the work herein or changes in medical knowl-
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that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions
or for the results obtained from use of such information. Readers are encouraged to confi rm the information contained herein with
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Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary
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Printed in the United States
978-1-60406-177-2
To my two sons, Manuel and Emilio, who keep me alive and happy, and to Michelle who has given me the energy and
enthusiasm to see life from a diff erent perspective.
—Hector Ferral
To my wife, Cynthia, for her endless love and support, and to my son, Matthew—a precious gift to me just weeks before
publication of this book.
—Jonathan Lorenz
RadCases Series Preface
The ability to assimilate detailed information across the other case-based radiology review books, we removed the
entire spectrum of radiology is the Holy Grail sought by guesswork by providing clear annotations and descriptions
those preparing for their trip to Louisville. As enthusiastic for all images. In our opinion, there is nothing worse than
partners in the Thieme RadCases series who formerly took being unable to locate a subtle fi nding on a poorly repro-
the examination, we understand the exhaustion and frus- duced image even after one knows the fi nal diagnosis.
tration shared by residents and the families of residents The electronic cases expand on the printed book and
engaged in this quest. It has been our observation that de- provide a comprehensive review of the entire subspecialty.
spite ongoing eff orts to improve Web-based interactive da- Thousands of cases are strategically designed to increase the
tabases, residents still fi nd themselves searching for mate- resident’s knowledge by providing exposure to additional
rial they can review while preparing for the radiology board case examples—from basic to advanced—and by exploring
examinations and remain frustrated by the fact that only a “Aunt Minnie’s,” unusual diagnoses, and variability within
few printed guidebooks are available, which are limited in a single diagnosis. The search engine gives the resident a
both format and image quality. Perhaps their greatest source fi ghting chance to fi nd the Holy Grail by creating individual-
of frustration is the inability to easily locate groups of cases ized, daily study lists that are not limited by factors such as
across all subspecialties of radiology that are organized and radiology subsection. For example, tailor today’s study list to
tailored for their immediate study needs. Imagine being able cases involving tuberculosis and include cases in every sub-
to immediately access groups of high-quality cases to arrange specialty and every system of the body. Or study only tho-
study sessions, quickly extract and master information, and racic cases, including those with links to cardiology, nuclear
prepare for theme-based radiology conferences. Our goal in medicine, and pediatrics. Or study only musculoskeletal
creating the RadCases series was to combine the popular- cases. The choice is yours.
ity and portability of printed books with the adaptability, As enthusiastic partners in this project, we started small
exceptional quality, and interactive features of an electronic and, with the encouragement, talent, and guidance of Tim
case-based format. Hiscock at Thieme, we have continued to raise the bar in our
The intent of the printed book is to encourage repeated eff ort to assist residents in tackling the daunting task of as-
priming in the use of critical information by providing a por- similating massive amounts of information. We are passion-
table group of exceptional core cases that the resident can ate about continuing this journey, planning to expand the
master. The best way to determine the format for these cases cases in our electronic series, adapt cases based on direct
was to ask residents from around the country to weigh in. feedback from residents, and increase the features intended
Overwhelmingly, the residents said that they would prefer a for board review and self-assessment. As the National Board
concise, point-by-point presentation of the Essential Facts of of Medical Examiners converts the American Board of Radi-
each case in an easy-to-read, bulleted format. Diff erentials ology examination from an oral to an electronic format, our
are limited to a maximum of three, and the fi rst is always series will be the one best suited to meet the needs of the
the actual diagnosis. This approach is easy on exhausted next generation of overworked and exhausted residents in
eyes and provides a quick review of Pearls and Pitfalls as in- radiology.
formation is absorbed during repeated study sessions. We
worked hard to choose cases that could be presented well in Jonathan Lorenz, MD
this format, recognizing the limitations inherent in repro- Hector Ferral, MD
ducing high-quality images in print. Unlike the authors of Chicago, IL
Preface
The passion we both share for teaching residents serves not to see competence in diagnosis, treatment options, basic
only as our daily motivation, but as the foundation for our technical knowledge, and clinical follow-up—all emphasized
academic careers and the reason we teamed up to write in the Essential Facts and Pearls and Pitfalls of this book.
Interventional Radiology, part of the RadCases series. If you Your success depends on repeated priming of these details
are a resident considering buying this book, you should while reviewing a core set of cases covering the most com-
know that it has taken us about 10 years to compile these mon diagnoses and interventional procedures. This printed
cases, and we have used them to train our residents and book makes repeated priming possible by exposing you to
fellows and to prepare them for the oral board exams. Ac- essential cases that are most likely to appear on the oral
tually, it was our residents who gave us the idea and en- exam, including the gamut of vascular and nonvascular, di-
couragement to undertake this project after our collection agnostic and interventional cases. In the home stretch, your
of cases led to a track record of consistent success on the goal should be to review core concepts while minimizing
boards. You should also know that we remember what it nonessential and distracting details. The electronic compo-
was like to stand in your shoes. We remember combing nent consists of sortable, concise, high-resolution cases that
through everything from review books to encyclopedias will help you achieve this goal.
of endless information to fi nd a way to absorb impossible Cases 1 to 50 were authored by Hector Ferral and cases 51
amounts of knowledge in a few month-long subspecialty to 100 were authored by Jonathan Lorenz.
rotations—all the while manning our clinical responsibili-
ties. Our frustration over the lack of concise, accurate, and
Acknowledgments
comprehensive interventional radiology review materials
for the oral board exam was the seed for the development We would like to thank Timothy Hiscock at Thieme
of this book and, ultimately, the RadCases series. Publishers for his expertise, patience, and encouragement
The oral board examiner in interventional radiology wants and Adriana diGiorgio for her expert technical assistance.
