Table Of ContentRibes · Luna · Ros
Learning Diagnostic Imaging
RibesLunaRos.indb I 18.03.2008 12:48:40
R.Ribes · A.Luna · P.R.Ros
(Eds.)
Learning
Diagnostic Imaging
100 Essential Cases
With Contributions by
L. Alcala Mata · M. Alvarez Benito · F. Bravo-Rodriguez · J. Camps Herrero
P. Daltro · R. Diaz-Aguilera · S. Espejo · E. Feliu · L. C. Hygino Cruz Jr.
J. Lopez Mora · A. Luna Alcala · S. Mejia · R. do A. Nogueira · M. T. C. Porto
M. Potolicchio · A. C. Rebollo Aguire · R. Ribes · S. E. Rossi · P. Segui
J. A. Vallejo Casas · J. C. Vilanova
With 347 Figures in 397 Separate Illustrations, 50 in Color
123
RibesLunaRos.indb III 18.03.2008 12:48:44
Ramon Ribes,
MD, PhD
Interventional Radiology and MR Units
Reina Sofi a University Hospital
14005 Cordoba
Spain
Antonio Luna,
MD
Chief, MR Unit
Clinica Las Nieves
Sercosa
23007 Jaen
Spain
Pablo R. Ros
, MD, MPH
Chairman, Department of Radiology
Sant Pau Hospital
Autonomous University
08025 Barcelona
Spain
and
Professor, Department of Radiology
Harvard Medical School
Brigham & Women’s Hospital
75 Francis St.
Boston MA 02115
USA
ISBN 978-3-540-71206-0 e-ISBN 978-3-540-71207-7
DOI 10.1007/978-3-540-71207-7
Library of Congress Control Number: 2007943071
© 2008, Springer-Verlag Berlin Heidelberg
This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned,
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springer.com
RibesLunaRos.indb IV 18.03.2008 12:48:44
To my daughters
Rosario Reyes
and
Ramon Ribes
To all
teachers
my
especially to the most motivating ones
Antonio Luna
To all
teachers students
my and ,
for enriching me with energy and
enthusiasm. Among my teachers,
a special mention to
parents
my
(for my father, in memoriam),
brother children wife
my , my and my
Pablo R. Ros
RibesLunaRos.indb V 18.03.2008 12:48:44
Preface
In my fi rst days as a Radiology resident I remember myself in dire need of a book in
which I could begin to study the specialty. In those days I was thirsty for radiologi-
cal knowledge and was recommended a classic manual on conventional chest X-ray
which was the very same the oldest radiologist of the staff had studied when he was
a beginner. Unfortunately the book I was recommended covered less than 5% of the
specialty as it is conceived nowadays.
“Learning Diagnostic Imaging. A Teaching File” is intended to provide medical
students, residents of Radiology, and anybody else beginning to be involved in the
radiological world, with a useful tool that gives them a quick and comprehensive
overview of Radiology. With this book, written in a user-friendly format, Radiology
residents, nurses, technicians, and medical students would see their fi rst radiologi-
cal images in a sort of introduction of what will become their professional activities
in the rest of their lives.
One of the main problems that Radiology residents face throughout their resi-
dency is that in rounds and clinical sessions they receive information they cannot
apprehend because they lack the essential background needed to integrate what
they are taught. For example, when, in a radiological session, a resident is looking
at an angiogram and has no prior interventional radiology education, he/she in-
evitably misses the opportunity of learning by being exposed to a great deal of in-
formation without the necessary tools to assimilate it. Whenever a mammogram
is shown at the radiological session, a fi rst year resident, who has no prior training
on breast imaging, knowing beforehand that he is not supposed to be asked about
it, loses interest in the subject and it is likely that his mind drifts away until the
next case is shown. In clinical sessions, the level of concentration of residents is
optimal only in the cases they have prior education on.
With this book, residents independently of their year of residency, would count
on the foundations of the specialty as a whole and optimize their time in rounds and
clinical sessions. Although initially aimed at Radiology residents, the book would
be useful, on the one hand, for medical students, Radiology nurses and technicians
and, on the other hand, for senior radiologists and residents and referring physi-
cians of other specialties. As a way of example, the breast imaging senior radiologist
would have a basic overview of cardiac imaging at his disposal in just a few pages
that otherwise would be impossible for him because no mammographer is supposed
to be interested in classic cardiac imaging books as no cardiovascular radiologist
has any interest in breast imaging manuals.
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VIII Preface
The scarcity of books of this sort is easily understandable taking into account
that Radiology is divided up in many subspecialties that constitute a universe of
their own. To convey an overall view of the specialty is extremely diffi cult nowadays
and will be even more diffi cult in the future because, due to the fragmentation of the
specialty, the old-days only Radiological session, which was attended by the whole
Department, has been replaced by a myriad of subspecialty sessions that, by defi ni-
tion, cannot be attended by the entire Radiology Department.
Cordoba, November 22, 2007 Ramon Ribes
RibesLunaRos.indb VIII 18.03.2008 12:48:44
Contents IX
Contents
1 Breast Imaging
Marina Alvarez Benito and Julia Camps Herrero
Melcior Sentis Criville and Maria Martinez Galvez (Contributors) . . . . . . . . . . . . . . . . 1
Case 1 Ductal Carcinoma in Situ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Case 2 Invasive Ductal Carcinoma with MRI Staging . . . . . . . . . . . . . . . . . . . 4
Case 3 Breast Implant Rupture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Case 4 Papillary Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Case 5 Microcalcifi cations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Case 6 Architectural Distortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Case 7 Breast Cancer in Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Case 8 Breast Cancer and Simple Cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Case 9 Breast Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Case 10 Locorregional Estadifi cation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Further Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2 Cardiovascular Imaging
Eliosa Feliu, Ramon Ribes, and Sergio Mejia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Case 1 Acute Myocardial Infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Case 2 Hypertrophic Cardiomyopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Case 3 Arrhythmogenic Right Ventricular Dysplasia . . . . . . . . . . . . . . . . . . . 32
Case 4 Myocarditis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Case 5 Aortic Coarctation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Case 6 Constrictive Pericarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Case 7 Restrictive Cardiomyopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Case 8 Congenital Anomalies of Coronary Arteries . . . . . . . . . . . . . . . . . . . . 42
Case 9 Coronary Artery S Stenoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Case 10 Aortocoronary Bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Further Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
3 Thoracic Radiology
Santiago E. Rossi and Joaquina Lopez Mora . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Case 1 Usual Interstitial Pneumonia (UIP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Case 2 Lymphangitic Carcinomatosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Case 3 Thrombotic Pulmonary Embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Case 4 Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Case 5 Thoracic Neurofi broma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Case 6 Hodgkin Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Case 7 Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Case 8 Bronchiectasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Case 8 Malignant Mesothelioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Case 10 Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Further Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
RibesLunaRos.indb IX 18.03.2008 12:48:44
X Contents
4 Gastrointestinal System and Disorders of the Liver, Pancreas, Spleen,
and Biliary System
Antonio Luna Alcala, Lidia Alcala Mata, and Ramon Ribes . . . . . . . . . . . . . 77
Case 1 Acute Cholecystitis and Choledocholithiasis with
Secondary Pancreatitisand and Hepatic Abscess . . . . . . . . . . . . . . . . 78
Case 2 Cirrhosis with Portal Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Case 3 Hepatic Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Case 4 Pancreatic Insulinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Case 5 Splenic Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Case 6 Crohn’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Case 7 Complicated Diverticulitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Case 8 Hiatal Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Case 9 Primary Small Bowel Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Case 10 Duodenal Gallstone Ileus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Further Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
5 Genitourinary, Gynecological, and Obstetrical Imaging
Antonio Luna Alcala, Marcelo Potolicchio, and Lidia Alcala Mata . . . . 103
Case 1 Adrenal Myelolipoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Case 2 Complicated Cortical Renal Cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Case 3 Prostate Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Case 4 Retroperitoneal Liposarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Case 5 Acute Obstruction by Ureteral Lithiasis . . . . . . . . . . . . . . . . . . . . . . . . 112
Case 6 Adenomyosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Case 7 Cervical Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Case 8 Endometrial Polyp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Case 9 Fetal Lissencephaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Case 10 Ovarian Serous Cystoadenocarcinoma . . . . . . . . . . . . . . . . . . . . . . . . . 122
Further Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
6 Musculoskeletal Imaging
Joan C. Vilanova and Ramon Ribes
Sandra Baleato (Contributor) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Case 1 Osteomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Case 2 Acute Meniscal and Ligament Tears of the Knee . . . . . . . . . . . . . . . . . 130
Case 3 Radius Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Case 4 Ewing Sarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Case 5 Schwannoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Case 6 Soft-Tissue Liposarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Case 7 Chordoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Case 8 Osteonecrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Case 9 Bone Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Case 10 Enchondroma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Further Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
7 Neuroimaging and Head and Neck Imaging
F. Bravo-Rodriguez and Rocio Diaz-Aguilera . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Case 1 Meningioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Case 2 Multiple Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Case 3 Cerebral Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Case 4 Acute Head Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Case 5 Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
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Contents XI
Case 6 Subarachnoid Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Case 7 Cerebral Venous Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Case 8 Cavernous Angioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Case 9 Epidermoid Cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Case 10 Juvenile Nasopharyngeal Angiofi broma . . . . . . . . . . . . . . . . . . . . . . . . 172
Further Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
8 Nuclear Medicine
Juan Antonio Vallejo Casas and Angel C. Rebollo Aguirre
Luisa Maria Mena Bares (Contributor) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Case 1 Brain Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Case 2 Gastrointestinal Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Case 3 Infl ammatory Bowel Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Case 4 Movement Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
Case 5 Obstructive Uropathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Case 6 Thromboembolic Pulmonary Disease . . . . . . . . . . . . . . . . . . . . . . . . . . 190
Case 7 Coronary Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
Case 8 Parathyroid Adenoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
Case 9 Pulmonary Solitary Node. PET-CT Evaluation . . . . . . . . . . . . . . . . . . 196
Case 10 Lymphoma. PET-CT Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Further Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
9 Pediatric Radiology
Pedro Daltro, L. Celso Hygino Cruz Jr., Renata do A. Nogueira,
and Miriam T. C. Porto . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Case 1 Hip Dysplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Case 2 Hypertrophic Pyloric Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Case 3 Intussusception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
Case 4 Round Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
Case 5 Congenital Cystic Adenomatoid Malformation . . . . . . . . . . . . . . . . . . 214
Case 6 Neuroblastoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
Case 7 Wilms Tumor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Case 8 Medulloblastoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
Case 9 Corpus Callosum Agenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Case 10 Tethered Cord . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
Further Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
10 Ultrasound Imaging
Pedro Segui and Simona Espejo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Case 1 Acute Cholecystitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
Case 2 Appendicitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Case 3 Acute Colonic Diverticulitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Case 4 Epididymoorchitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
Case 5 Deep Venous Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
Case 6 Hodgkin’s Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
Case 7 Abdominal Wall Endometriosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
Case 8 Carotid Artery Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
Case 9 Carotid Artery Dissection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248
Case 10 Choroidal Melanoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
Further Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
RibesLunaRos.indb XI 18.03.2008 12:48:45
Description:In my ? rst days as a Radiology resident I remember myself in dire need of a book in which I could begin to study the specialty. In those days I was thirsty for radiolo- cal knowledge and was recommended a classic manual on conventional chest X-ray which was the very same the oldest radiologist of t
