Table Of Content00_HallerTitelei_Hardcover 22.10.2004 12:59 Uhr Seite I
Jack O.Haller · Thomas L.Slovis · Aparna Joshi
Pediatric Radiology
3rd Edition
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Jack O.Haller
(February 9,1944–June 15,2004)
Teacher,Colleague,Friend
To Jack:A Farewell to a Friend Suddenly
We are suspended without him
Suddenly In mid sentence
A dawn His presence,a gift
The world is not the same anymore A gift to those who knew him
The days always follow one another We paid no attention to the clocks
Endlessly He was there.
No beginning,no end
I accepted it. I know
The days will start to follow each other
Suddenly Again
The world seems suspended But there will be different days
Time halted in mid sentence The clocks will start again
A day broke the sequence But never the same clocks.
The clocks marking time
Stopped. John C.Leonidas,June 2004
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Pediatric
Jack O.Haller
Thomas L.Slovis
Aparna Joshi
Radiology
Third Edition
With 286 Figures in 818 Separate Illustrations
and 28 Tables
12
3
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Jack O.Haller,MD
Professor ofRadiology
Kings County Hospital,Downstate Medical Center
Health Science Center at Brooklyn,State University ofNew York
Brooklyn,NY,USA
Thomas L.Slovis,M.D.
Professor ofRadiology and Pediatrics
Pediatric Imaging Department,Children’s Hospital ofMichigan
3901 Beaubien Boulevard,Detroit,MI 48201,USA
Aparna Joshi,MD
Assistant Professor ofRadiology
Pediatric Imaging Department,Children’s Hospital ofMichigan
3901 Beaubien Boulevard,Detroit,MI 48201,USA
Title ofthe First Edition:
Haller/Slovis,Introduction to Radiology in Clinical Pediatrics
© 1984 by Year Book Medical Publishers,Inc.Chicago,London
Library ofCongress Controll Number:2004111250
ISBN 3-540-21354-6 Springer Berlin Heidelberg New York
ISBN 3-540-59059-5 2nd ed.Springer-Verlag Berlin Heidelberg New York
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Dedication:First Edition
To Adolfand Frieda Haller,my mentors,my inspiration,my parents.
J.O.H.
To Ellie,Michael,Debbie,Andy,and Lisa,my family,without whose love,
patience,and inspiration this project could not have been completed.
T.L.S.
Dedication:Second Edition
To Walter E.Berdon,Jerome M.Levine,David H.Baker,and Joseph O.
Reed,whose teaching and counsel molded our careers,and whose in-
tegrity and dedication to excellence in their craft had a profound influ-
ence on our lives.
J.O.H.
T.L.S.
Dedication:Third Edition
To my coauthor Tom Slovis,who for more than 30 years has been the
epitome of true friendship.His loyalty,care,camaraderie,and brother-
hood have been the mainstays ofmy career and personal support.He and
his wife Ellie have provided me and my family with love,kindness,re-
spect,and devotion,and I am grateful that I am blessed to have him as
my friend.
J.O.H.
To the medical students and residents who have stimulated this edition.
Their constant questions,suggestions,and enthusiasm encouraged me to
improve and update this work.I hope that the transfer ofthis knowledge
continues to improve our care ofchildren.
T.L.S.
To my parents,Asha and Sharadchandra Joshi,whose patience,guidance,
and love have shaped my life.
A.J.
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Preface to Third Edition
The third edition follows 20 years after our initial of- We continue the socratic approach of asking
fering.It updates the technology of pediatric imag- questions to stimulate the reader’s interest.There are
ing.It is designed for medical students and residents 30% more new pictures and more quiz cases.
in both pediatrics and radiology,nurse practition- We have attempted to write this book at several
ers, physician assistants, and all who take care of levels – the text for the medical student and nonradi-
children. ologist,the figures with images of various complex
This edition gets us back to basics with a new diseases and findings to further stimulate the radiol-
chapter on the effects of radiation in children. It ogy resident,and the further reading lists to encour-
deals more with what to order and why.The prolifer- age those who want to know more.
ation of imaging techniques is not a good thing if We hope you enjoy this “quick read.”
imaging replaces superb history taking,good physi-
cal examination,and excellent clinical judgment. The Authors
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VIII Preface to the First and Second Edition
Preface to First Edition
The idea for this book grew out ofour experience in these examinations to help the clinician discern the
teaching pediatric radiology to clinicians and stu- normal from the abnormal.A second goal is to help
dents.Clearly,there is a strong desire on the part of the pediatrician,house officer,and medical student
those taking care of children to familiarize them- learn the indications for various procedures,as well
selves with the rudiments of the pediatric radi- as to recognize some of the more common abnor-
ograph.While radiologists have primary responsibil- malities.This text is by no means meant to provide
ity for the interpretation of films, clinicians bring an in-depth discussion of various disease entities,
valuable insight and information.Often they present nor is it intended to catalog the various subtle radi-
additional important data or ask searching questions ographic findings in these entities.
that prompt a re-evaluation of the films so that a The radiographs in this volume are often repro-
more appropriate diagnosis may be obtained. duced to enhance a single finding under discussion,
While primers are available in adult radiology, often at the expense of other portions of the film.
comparable editions in pediatrics are lacking. We Also, arrows and letters have been kept to a mini-
have therefore adapted the teaching sessions of mum so as not to obscure the radiographs.
Joseph O.Reed,Director of Radiology at Children’s It is our hope that, by providing this primer for
Hospital of Michigan and Professor of Radiology at pediatric radiology, we will stimulate clinicians to
Wayne State University School of Medicine, as the visit the X-ray department,share in the interpreta-
framework for our text. In addition, Rosalind H. tion oftheir patients’films,and continue to stimulate
Troupin has generously allowed us to use some ofher us so that together we can provide optimal care for
ideas for this book,which is an elementary guide to children.
common pediatric radiographic examinations and
problems.It is our intent to provide an approach to Jack O.Haller · Thomas L.Slovis
Preface to Second Edition
Why did we write a 2nd edition? There were several hence,the added information on ultrasound,CT,and
reasons.First,the popularity of the first edition de- MRI.While it is hard to cover such complex fields in
manded a repeat.Students,housestaff,clinicians,and a book such as this,we have tried to give the reader at
directors ofradiology,pediatric radiology,and pedi- least a working practical introduction to the topics as
atric programs across the nation were continually they relate to pediatrics.
calling us to ask where they could obtain more We know,based on our experience with the first
copies.The first addition was simply sold out;there edition,that this volume will be helpful to clinicians
were no copies left. and housestafffrom both radiology and pediatric de-
Second,in our capacities as directors ofpediatric partments.But we have also found that family prac-
radiology departments,we also ran out ofcopies;we tice and emergency physicians,nurse practitioners,
found the first edition so helpful in acclimating our and physicians’ assistants profit from reading the
radiology and pediatric staffs to pediatric radiology, first edition; we have also geared our new text to-
that we needed new copies for ourselves. wards these groups as well.Enjoy!
Third,in the ten years since publication ofthe first
edition there have been major changes in the field of Jack O.Haller · Thomas L.Slovis
radiology.Therefore,we really needed to update it;
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Acknowledgments:Third Edition
The third edition was produced at Children’s Hospi- “as a student”and as the copy editor.She also did the
tal ofMichigan through the efforts ofthe audiovisu- index.Drs.David Bloom,Swati Mody,and John Crow-
al department, particularly Amanda Oberlee. She ley read our work and made helpful suggestions.
took all the photographs, collated them, and per- Dr.Alex Cacciarelli,a superb medical artist,con-
formed the labeling and computer refinement ofthe tributed all the new drawings.They are a wonderful
images. Jennifer Handley typed the entire manu- addition.
script multiple times until all of us “had enough.” We thank all the individuals for their fine work
Michele Klein-Fedyshin once again reviewed the text and dedication.
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X Acknowledgements ofthe First and Second Edition
Acknowledgments:First Edition
We wish to acknowledge a number of individuals academic pursuits and sustains a gratifying working
without whom this work would not have been com- milieu.
pleted.Drs.Ronald L.Poland,John K.Kelly,Harvey I. Drs.George B.Comerci,Lewis A.Barness,and C.
Wilner,and Alfredo Lazo offered helpful criticisms of Henry Kempe stimulated our interest in pediatrics
early drafts. Drs. Alkis Zingas, Alfredo Lazo, and and urged close rapport with our pediatric col-
Lawrence R. Kuhns were kind enough to lend us leagues.Dr.R.Parker Allen has been responsible for
computerized tomographic images and the nuclear first “turning on”many ofhis students to radiology.
medicine images found within the text. Virginia Drs. David H. Baker and Walter E. Berdon, our
Newman did yeoman work in typing and retyping mentors, godfathers, and friends, have always en-
numerous revisions of this manuscript over a two- couraged us and continue to serve as models of ex-
year period.Without her hard work,the task would cellence in pediatric radiology.
have been impossible. Dr. Joseph O. Reed (whose Reed’s Rules appear
Albert Paglialunga and Shelley Eshelman provid- throughout this book) has helped with his guidance,
ed the reproductions of the radiographs and the teaching,and critical appraisal ofthe manuscript.He
schematic diagrams,respectively.They were patient has provided this stimulus by emphasizing basic
and responsive. principles as a means to learning radiology and,in
Dr.Joshua A.Becker,a chairman and friend,has fact,medicine itself.
continued to provide support and encouragement for
Acknowledgments:Second Edition images perfect, and without his efforts the book
would not have been possible.Lastly,we would like to
We are grateful for the efforts of many individuals thank all ofthose who read,corrected,or contributed
who helped make this second edition possible.Par- to the many chapters.These include Joshua A.Becker
ticularly,we would like to thank Jennifer Handley for for his continued encouragement, members of the
typing the entire manuscript with endless correc- faculty at Children’s Hospital of Michigan (Gary
tions and modifications.Michele Klein reviewed the Amundson, Cristie Becker, David Corbett, John
manuscript both as a teaching tool and also as a Crowley, Daniel Eggleston, Sam Kottamasu, John
proofreader.Her suggestions and contributions were Pereira,and Susan Roubal),and to the authors who
invaluable.Cliff Roberts prepared all of the photo- allowed us to use pictures from other articles and
graphs in this text.He worked tirelessly to make the text in this edition.
