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2015v1.0
2
nd
EDITION
MÜLLER’S
IMAGING
OF THE
CHEST
EDITORS
CHRISTOPHER M. WALKER, MD
Associate Professor of Radiology
University of Kansas Medical Center
Kansas City, Kansas
JONATHAN H. CHUNG, MD
Associate Professor
Section Chief of Thoracic Radiology
Interim Vice Chair for Quality
Department of Radiology
The University of Chicago Medicine
Chicago, Illinois
ASSOCIATE EDITORS
STEPHEN B. HOBBS, MD
Assistant Professor
Department of Radiology and Medicine
University of Kentucky
Lexington, Kentucky
BRENT P. LITTLE, MD
Division of Thoracic Imaging
Department of Radiology
Massachusetts General Hospital
Boston, Massachusetts
CAROL C. WU, MD
Associate Professor
Department of Diagnostic Radiology
The University of Texas MD Anderson Cancer Center
Houston, Texas
1600 John F. Kennedy Blvd.
Ste 1600
Philadelphia, PA 19103-2899
MÜLLER’S IMAGING OF THE CHEST, SECOND EDITION ISBN: 978-0-323-46225-9
Copyright © 2019 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
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Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using such
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parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
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To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
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Previous editions copyrighted 2008 by Saunders, an imprint of Elsevier Inc.
Library of Congress Control Number: 2018953443
Publisher: Russell Gabbedy
Senior Content Development Specialist: Ann Ruzycka Anderson
Publishing Services Manager: Catherine Albright Jackson
Senior Project Manager: Claire Kramer
Design Direction: Ryan Cook
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To Eunhee, thank you for your constant support and pushing me to take on this project.
You truly make me a better man.
To Elsie, thank you for always loving me and making me aware of the things
that matter most in life.
To Lillian, thank you for always making me laugh and giving the biggest
hugs a dad could ever ask for.
CMW
To my parents, Kyu Youl and Bok Hee: Thank you for endlessly encouraging my curiosity.
To my daughter, Alexandra: Thank you for always being so excited to see me
when I come home; it is the only time I have felt like a rock star.
And to my loving wife, Aimee-Sue: Thank you for being the backbone of our family.
Your unending support and love always inspire me.
JHC
CONTRIBUTORS
Kiran Batra, MD Stephane L. Desouches, DO
Assistant Professor Assistant Professor of Radiology
Department of Radiology Medical College of Wisconsin
UT Southwestern Medical Center Milwaukee, Wisconsin
Dallas, Texas
Robert M. DeWitt, MD, Major, USAF MC
Matthew Bentz, MD Assistant Professor of Radiology
Assistant Professor Uniformed Services University of the Health Sciences
Department of Diagnostic Radiology Bethesda, Maryland
Oregon Health and Science University Landstuhl Regional Medical Center
Portland, Oregon Landstuhl, Germany
Marcelo F. Benveniste, MD Jeremy J. Erasmus, MD
Associate Professor Professor
Department of Diagnostic Radiology Department of Diagnostic Radiology
Thoracic Section The University of Texas MD Anderson Cancer Center
The University of Texas MD Anderson Cancer Center Houston, Texas
Houston, Texas
Stephen K. Frankel, MD
Anupama Brixey, MD Chief Medical Officer
Department of Diagnostic Radiology Professor of Medicine
Oregon Health and Science University Division of Pulmonary, Critical Care, and Sleep Medicine
Portland, Oregon Department of Medicine
National Jewish Health
Juliana Bueno, MD Denver, Colorado
Assistant Professor of Radiology
Department of Radiology and Medical Imaging Tomás Franquet, MD
University of Virginia Chief, Section of Thoracic Imaging
Charlottesville, Virginia Department of Radiology
Hospital de Sant Pau
Suzanne C. Byrne, MD, FRCPC Barcelona, Spain
Clinical Assistant Professor of Radiology
Department of Radiology Cristina S. Fuss, MD
Memorial University Associate Professor
St. John’s, Newfoundland, Canada Department of Diagnostic Radiology
Oregon Health and Science University
Brett W. Carter, MD Portland, Oregon
Associate Professor
Department of Diagnostic Radiology Sherief Garrana, MD
The University of Texas MD Anderson Cancer Center Resident Physician
Houston, Texas Department of Thoracic Radiology
University of Missouri–Kansas City/Saint Luke’s Hospital of
Jonathan H. Chung, MD Kansas City
Associate Professor Kansas City, Missouri
Section Chief of Thoracic Radiology
Interim Vice Chair for Quality Matthew D. Gilman, MD
Department of Radiology Division of Thoracic Imaging and Intervention
The University of Chicago Medicine Massachusetts General Hospital
Chicago, Illinois Boston, Massachusetts
Patricia M. de Groot, MD J. David Godwin, MD
Associate Professor Professor of Radiology
Department of Diagnostic Radiology Department of Radiology
The University of Texas MD Anderson Cancer Center University of Washington
Houston, Texas Seattle, Washington
vi
Contributors vii
Daniel R. Gomez, MD John P. Lichtenberger, MD
Associate Professor Associate Professor of Radiology
Department of Radiation Oncology Uniformed Services University of the Health Sciences
The University of Texas MD Anderson Cancer Center Bethesda, Maryland
Houston, Texas
Rebecca M. Lindell, MD
Ashish Gupta, MD Assistant Professor
Assistant Professor Department of Radiology
Department of Medical Imaging Mayo Clinic
University of Ottawa Rochester, Minnesota
Ottawa, Ontario, Canada
Brent P. Little, MD
Vedant Gupta, MD Division of Thoracic Imaging
Assistant Professor of Medicine Department of Radiology
University of Kentucky College of Medicine Massachusetts General Hospital
Lexington, Kentucky Boston, Massachusetts
Thomas E. Hartman, MD Jaume Llauger, MD
Professor Chief, Section of Musculoskeletal Imaging
Department of Radiology Department of Radiology
Mayo Clinic Hospital de la Santa Creu i Sant Pau
Rochester, Minnesota Universitat Autònoma de Barcelona
Barcelona, Spain
Stephen B. Hobbs, MD
Assistant Professor Andrea L. Magee, MD
Department of Radiology and Medicine Resident Radiologist
University of Kentucky Department of Radiology
Lexington, Kentucky The University of Chicago
Chicago, Illinois
Yeon Joo Jeong, MD
Department of Radiology Victorine V. Muse, MD
Pusan National University Hospital Assistant Professor of Radiology
Pusan National University School of Medicine Harvard Medical School
Busan, South Korea Massachusetts General Hospital
Boston, Massachusetts
Michael A. Kadoch, MD
Assistant Professor of Clinical Radiology Justin M. Oldham, MD, MS
Department of Radiology Assistant Professor
University of California–Davis Department of Internal Medicine
Sacramento, California Division of Pulmonary, Critical Care, and Sleep Medicine
University of California–Davis
Jeffrey S. Klein, MD Sacramento, California
A. Bradley Soule and John P. Tampas Green and Gold
Professor of Radiology Melissa Price, MD
Department of Radiology Instructor in Radiology
University of Vermont College of Medicine Division of Thoracic Imaging and Intervention
Burlington, Vermont Massachusetts General Hospital
Boston, Massachusetts
Sarah T. Kurian, MD
Department of Radiology Steven L. Primack, MD
University of Missouri–Kansas City Professor and Vice Chair
Kansas City, Missouri Department of Diagnostic Radiology
Oregon Health and Science University
Kyung Soo Lee, MD Portland, Oregon
Department of Radiology
Samsung Medical Center
Sungkyunkwan University School of Medicine
Seoul, South Korea
viii Contributors
Bradley S. Sabloff, MD Mylene T. Truong, MD
Professor Professor
Department of Diagnostic Radiology Department of Diagnostic Radiology
The University of Texas MD Anderson Cancer Center The University of Texas MD Anderson Cancer Center
Houston, Texas Houston, Texas
Jean M. Seely, MDCM, FCRPC Emily B. Tsai, MD
Associate Professor Department of Radiology
University of Ottawa Stanford University
Head of Breast Imaging Section Stanford, California
Department of Medical Imaging
The Ottawa Hospital Chitra Viswanathan, MD
Clinician Investigator Professor
Ottawa Hospital Research Institute Department of Diagnostic Radiology
Ottawa, Ontario, Canada Division of Diagnostic Imaging
The University of Texas MD Anderson Cancer Center
Phillip A. Setran, MD Houston, Texas
Radiology Resident
Department of Diagnostic Radiology Christopher M. Walker, MD
Oregon Health and Science University Associate Professor of Radiology
Portland, Oregon University of Kansas Medical Center
Kansas City, Kansas
Girish S. Shroff, MD
Associate Professor Charles S. White, MD
Department of Diagnostic Radiology Professor
The University of Texas MD Anderson Cancer Center Department of Diagnostic Radiology
Houston, Texas University of Maryland
Baltimore, Maryland
Justin T. Stowell, MD
Resident Carol C. Wu, MD
Department of Radiology Associate Professor
University of Missouri–Kansas City Department of Diagnostic Radiology
Kansas City, Missouri The University of Texas MD Anderson Cancer Center
Houston, Texas
Nicola Sverzellati, MD, PhD
Professor of Radiology
Department of Medicine and Surgery
University of Parma
Parma, Italy
FOREWORD
The aim of this second edition of Imaging of the Chest is to provide diagnosis, while knowledge of the pathologic findings allows a
a succinct, state-of-the art overview of imaging of the thorax. We better understanding of the patterns of abnormalities seen on
congratulate Drs. Christopher Walker and Jonathan Chung in the radiologic images.
achieving this goal by combining their outstanding talents as editors As the editors, we were delighted with the quality of the first
and their ability to obtain the collaboration of an exceptional edition and very thankful to the numerous authors who were
team of internationally renowned chest radiologists to write responsible for its success. There have been, however, many major
chapters in their fields of expertise. The new edition includes a changes and new developments since the publication of that
truly up-to-date review of the clinical, radiologic, and pathologic edition in 2008, which led to the need for a major revision and
manifestations of lung diseases and several hundred new images update. We chose to pass on the new edition to a young team
that provide excellent illustrations of the latest technologic advances. of editors with the talent, energy, and dedication required in
The emphasis of this book, similar to daily practice, is on planning, organizing, and completing this monumental endeavor.
chest radiography and computed tomography (CT). However, We are very pleased to see that they managed to improve the
as is also required in clinical practice, it includes the indications quality of the book and believe that it will be extremely useful
and characteristic findings on magnetic resonance imaging and, to radiology residents, chest radiology fellows, pulmonary physi-
when applicable, scintigraphy, positron emission tomography cians, thoracic surgeons, and general radiologists with an interest
(PET), integrated PET-CT imaging, and ultrasound. The book in chest imaging.
also provides a summary of the clinical manifestations and
pathologic findings. The clinical history is always helpful and Nestor L. Müller
often essential for an accurate diagnosis or appropriate differential C. Isabela Silva Müller
ix
PREFACE
We are honored and humbled to be the editors of the second a single-volume reference. Needless to say, this was challenging,
edition of Müller’s Imaging of the Chest. We are indebted to the but we are quite proud of the end product and hope you will
previous editors, Drs. Nestor Müller and Isabela Silva, as well agree that essential content has not been excluded. The first part
as their Associate and Assistant Editors, Drs. David Hansell, Kyung of this book deals with normal imaging appearance of the thorax
Soo Lee, and Martin Rémy-Jardin, for their extraordinary work on chest radiography and CT with detailed discussions of thoracic
in directing and creating the first edition of this textbook and anatomy. Truly, one does not know what abnormal is until one
organizing a team of some of the most esteemed chest radiologists. knows what normal is. The second part of this book approaches
The authoritative and comprehensive content in the first edition thoracic imaging from the “findings” aspect rather than from
of Imaging of the Chest made it the clear gold standard reference the diagnosis side. This is likely most relevant to readers of this
in thoracic imaging. When we were first offered the opportunity textbook, given that this is how patients present: with an unknown
to edit this textbook, we were reluctant because the first edition diagnosis but with abnormalities on chest imaging. Finally, the
was a hard act to follow. However, the opportunity to have a third part is arranged in a diagnosis or diagnostic category
hand in the second iteration of the textbook, which we used as approach, as is typical of most textbooks.
our personal go-to reference, was too hard to turn down. Thank- Specific highlights include updates on lung cancer screening
fully, our wives urged us to take on this project lest we and an updated review of pulmonary fibrosis and interstitial lung
kick ourselves in the future. Given the daunting task of updating disease management and diagnosis. In addition, four new chapters
and editing the authoritative content assembled by the previous were created to more fully include topics pertinent to chest imagers:
world-class team of chest radiologists, we knew we would Leukemia, Idiopathic Pleuroparenchymal Fibroelastosis, Interstitial
need help. Our associate editors, Drs. Stephen Hobbs, Brent Pneumonia with Autoimmune Features, and Noninfectious Lung
Little, and Carol Wu, were all obvious choices to help us and Stem Cell Transplantation Complications.
direct this endeavor given their superior clinical training, unique This book would not have been possible without the support
clinical backgrounds, and complementary clinical and academic of our colleagues and mentors. We thank, first, all our mentors
interests. at the University of Washington and the Massachusetts General
Chest radiography continues to be the most commonly Hospital for cultivating our passion for cardiopulmonary imaging
obtained imaging study throughout the world. In many patients, and guiding us in the gauntlet of academic radiology; second,
a high-quality chest radiograph, combined with appropriate specific leaders in the field, including Drs. David A. Lynch and
clinical information, allows for accurate diagnosis. However, in J. David Godwin, whom we had the pleasure of working with
many cases, it is helpful to obtain chest computed tomography and who continually provided their support and advice on all
(CT) imaging given its higher contrast resolution. In recent years, matters; and third, our trainees, who have always kept us honest
the line between high-resolution CT of the chest and standard in regard to what we knew (or thought we knew). We hope you
CT has blurred as volumetric helical CT acquisition becomes enjoy reading this textbook (although based on your track record,
the norm, allowing for reconstruction of images in any plane we assume you will get around to it next rotation). Finally, we
and in virtually any slice thickness. Contrast-enhanced chest CT thank the wonderful staff at Elsevier who have made this endeavor
and chest CT angiography are highly valuable tools in the assess- possible, including but not limited to Robin Carter, Ann Anderson,
ment of suspected malignancy, vascular abnormalities, and Claire Kramer, and Margaret Nelson.
thromboembolic disease. Magnetic resonance imaging (MRI) This book is aimed at clinical radiologists, pulmonologists,
and positron emission tomography (PET) imaging are useful trainees, and any other health care professionals interested in
adjuncts in thoracic imaging, specifically in the setting of known thoracic imaging. It provides a concise but comprehensive
or suspected malignancy. Although specialized centers have used overview of imaging findings of thoracic diseases. We hope that
MRI and PET imaging for evaluation of nonmalignant pulmonary the second edition of Müller’s Imaging of the Chest will be a
abnormalities, these are still mostly avenues for research rather valuable resource for the thoracic health care community and
than accepted clinical standards. will ultimately improve patient care.
In the second edition of this textbook, we aim to provide a
comprehensive review of thoracic imaging while simultaneously Jonathan H. Chung, MD
compressing the size of the textbook from a two-volume set to Christopher M. Walker, MD
x
