Radiology of Chest Diseases

391 Pages·2006·135.734 MB·English

by  Sebastian Lange, Geraldine Walsh

I
II
III
Radiology
of Chest Diseases
Sebastian Lange, MD
Professor and Chairman
Department of Radiology
Knappschaftshospital
Recklinghausen
Germany
Geraldine Walsh, MRCP, FRCR, FRANZCR
Consultant Radiologist
Department of Radiology
Royal Berkshire Hospital
Reading
United Kingdom
With a contribution by Michael Montag
Third edition, fully revised and updated
1118 illustrations
35 tables
Thieme
Stuttgart · New York
IV
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V
To Maritta, Constantin,
Caroline, Christian, and Clemens
Sebastian Lange
To Colin
Geraldine Walsh
VI
VII
Preface
Almostadecadehaspassedsincethepublicationofthe Inthistext,wehavetriedtoconveyhowtheseexcit-
second edition of Radiology of Chest Diseases in 1997. ingadvancesintechnologyfitintotheclinicalsettingof
This period has seen tremendous advances in imaging cardiothoracicimagingevaluation.
technology. We also recognize the ever-increasing availability
Single-slicehelicalCThasgivenwaytomulti-detec- anduseofCTasan“early”second-lineimagingtoolin
torrowCT(MDCT),andwithincreasingnumbersofde- assessment of the patient with suspected pulmonary
tectorswemovetowardtheconceptof“isotropic”spa- diseaseandhaveplacedagreateremphasisontherole
tialresolution.Thishasbeencombinedwithdecreased of high-resolution/thin-section CT in evaluation of
scantimesandimprovedtemporalresolution.Therapid parenchymallungdisease.
evolutionofCTtechnologyhasledtomarkedimprove- A new chapter on interventional procedures in the
ments in the quality of thoracic CT studies and has al- thorax describes a spectrum of procedures from the
lowedustocontemplateandperformwithsomesuccess standardimage-guidedbiopsyanddrainagethroughto
cardiacevaluationandCTcoronaryangiography. the more specialized interventions of pulmonary AVM
Positron emission tomography (PET)/PET-CT has andpulmonaryfalseaneurysmembolization.
beenincorporatedintoeverydayclinicalpracticeinthe Onceagain,wehopethatthistextconveysthefasci-
pastdecadeandtodayplaysasignificantroleinimaging nating diversity of cardiothoracic radiology and that it
evaluationofthoracicdisease,particularlyinoncologic willproveausefulguidetothepractitionerintheevery-
stagingandassessment. dayclinicalsetting.
Advancesinmagneticresonanceimaging(MRI)today
allowimprovedcardiacevaluationandparticularlymy- SebastianLange,MD
ocardialfirst-passperfusionandviabilityassessment. GeraldineWalsh,MRCP,FRCR,FRANZCR
VIII
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Table of Contents
1 Examination Technique and Normal Findings 1
RadiographicExamination....................... 2 VascularSystem ............................. 20
FrontalChestRadiograph..................... 2 TheMediastinum ............................ 24
LateralChestRadiograph ..................... 3 ConventionalTomography ...................... 25
ObliqueViews ............................... 3 ComputedTomography ......................... 28
ApicalLordoticView ......................... 4 RadionuclideImaging ........................... 38
Fluoroscopy ................................. 4 LungScintigraphy............................ 38
Scatter-ReductionGrids ...................... 4 MyocardialPerfusionScintigraphy ............ 39
TheNormalChestRadiograph ................... 5 PositronEmissionTomography(PET)
StructuresoftheChestWall .................. 5 andPET-CT .................................. 41
Diaphragm .................................. 9 Ultrasound ..................................... 42
Pleura ....................................... 9 PulmonaryAngiography ........................ 42
LungParenchyma ............................ 16 Bronchography ................................. 45
TracheobronchialSystem ..................... 18 MagneticResonanceImaging.................... 47
2 Malformations 50
BronchopulmonarySequestrations............... 50 CongenitalBronchialAtresia..................... 60
HypogeneticLungSyndrome VascularMalformations ......................... 61
(ScimitarSyndrome) ............................ 53 PulmonaryArteriovenousMalformations
BronchogenicCysts ............................. 54 (AVM)....................................... 61
CongenitalCysticAdenomatoidMalformationof PartialAnomalousPulmonaryVenousDrainage
theLung(CCAM) ............................... 56 (PAPVD) ..................................... 61
PulmonaryAgenesis,Aplasia,andHypoplasia .... 57 HypoplasiaandAtresiaofthePulmonary
CongenitalLobarEmphysema ................... 59 Artery ....................................... 62
3 Infection and Inflammatory Disorders 64
Pneumonia ..................................... 64 Echinococciasis .............................. 89
LungAbscessandSepticPulmonaryEmboli ...... 69 Paragonimiasis .............................. 90
PulmonaryTuberculosis ......................... 72 Ascariasis.................................... 90
FungalDiseasesoftheLung ..................... 80 StrongyloidiasisandAnkylostomiasis ......... 91
Candidiasis .................................. 80 Sarcoidosis ..................................... 91
Aspergillosis ................................. 81 IdiopathicInterstitialPneumonias ............ 95
Histoplasmosis .............................. 84 AcquiredImmunodeficiencySyndrome........... 97
Coccidioidomycosis .......................... 84 Infections ................................... 97
Actinomycosis ............................... 85 IntrathoracicMalignancy ..................... 98
Nocardiosis .................................. 85 LymphoproliferativeDisorders................ 99
Cryptococcosis(Torulosis) .................... 86 AutoimmuneDisorders/ConnectiveTissue
ParasiticInfections.............................. 86 Diseases........................................ 100
Amebiasis ................................... 86 SystemicLupusErythematosus ............... 100
Toxoplasmosis ............................... 87 RheumatoidArthritis......................... 100
PneumocystisJiroveciPneumonia ProgressiveSystemicSclerosis(PSS) .......... 101
(PreviouslyKnownasPneumocystisCarinii SjögrenSyndrome ........................... 102
Pneumonia—PCP) ............................ 87 Dermatomyositis ............................ 102
Schistosomiasis .............................. 88 AnkylosingSpondylitis(AS) .................. 102