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Diagnostic Imaging

Clinical Imaging: An Atlas of Differential Diagnosis by Ronald L. Eisenberg MD

By Ronald L. Eisenberg MD

Dr. Eisenberg's top vendor is now in its 5th Edition—with brand-new fabric on puppy and PET/CT imaging and increased assurance of MRI and CT. that includes over 3,700 illustrations, this atlas courses readers during the interpretation of abnormalities on radiographs. The emphasis on development acceptance displays radiologists' daily needs...and is beneficial for board guidance. equipped by way of anatomic region, the booklet outlines and illustrates regular radiologic findings for each affliction in each organ method. Tables at the left-hand pages define stipulations and attribute imaging findings...and provide reviews to steer prognosis. photographs at the right-hand pages illustrate the main findings famous within the tables. A significant other site helps you to determine and extra sharpen your diagnostic talents.

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B Pericardial cyst. Axial spin-echo MRI at the base of the heart. An intermediate signal intensity smooth mass extrinsic to the heart is identified (arrow). g. g. the GI tract, kidney, testis, head and neck tumours, breast) MIDDLE MEDIASTINAL MASSES Low-attenuation lymph node enlargement. * Tuberculous lymphadenopathy. * Massively enlarged lymph nodes. Massive anterior mediastinal nodal enlargement secondary to Hodgkin’s disease. * B Non-small cell lung carcinoma. (A) Axial and (B) coronal CT demonstrating massive mediastinal adenopathy partially encasing the thoracic aorta (arrows) as well as compressing and nearly occluding the left main pulmonary artery (arrowheads).

A) PA XR of the trachea reveals a tracheal stenosis (arrow) proximal to a tracheostomy stoma (open arrow). The proximal oesophagus is distended with air (arrows) close to the fistula. { TRACHEAL DISORDERS TRACHEAL NEOPLASMS Benign Definition This is most commonly a hamartoma, leiomyoma, neurogenic tumour or lipoma CT A well-demarcated and round lesion (< 2cm) ▶ a smoothly marginated intraluminal polyp (hamartomas and lipomas may demonstrate fat attenuation) Malignant Definition These are uncommon – the vast majority are a squamous cell or adenoid cystic carcinoma CT A soft tissue mass (usually involving the posterior and lateral walls) ▶ it is often sessile and eccentric resulting in asymmetrical luminal narrowing ▶ can be polypoid and mostly intraluminal (with mediastinal extension seen in 30–40%) Secondary malignant neoplasms Definition These can be due to a haematogenous metastasis (commonly renal cell carcinoma and melanoma) or following direct local invasion CT Intraluminal soft tissue nodules and wall thickening A B Adenoid cystic carcinoma of the trachea.

Pancreatic pseudocyst. CECT shows a round posterior mediastinal cystic mass located behind the heart and demonstrating enhancing walls. { Extramedullary haematopoiesis showing smooth pleurally based masses and altered bone texture in this patient with thalassaemia. * Mediastinal lipomatosis. { Lateral thoracic meningocele. Non-contrast CT shows a well-marginated water attenuation mass arising from the spinal canal. Note the marked widening of the neural foramen. 2 ¡ MEDIASTINUM CONGENITAL ABSENCE OF THE PERICARDIUM DEFINITION • A congenital pericardial defect caused by vascular compromise to the pleuropericardial membrane during development • This varies from a small defect to complete (bilateral) absence of the pericardium ▶ complete absence commonly affects the left pericardium (bilateral and isolated right-sided lesions are very rare) CLINICAL PRESENTATION • Complete absence is usually asymptomatic ▶ partial absence may be complicated by herniation or cardiac chamber entrapment (particularly affecting the left atrial appendage) lung between the aorta and pulmonary artery (also between the left hemidiaphragm and cardiac silhouette) ▶ an ill-defined right cardiac border (due to leftward cardiac displacement and rotation) • Partial pericardial defect: varying degrees of pulmonary artery or left atrial appendage prominence ▶ the heart retains its normal position PEARLS • This is associated with congenital heart and lung anomalies: ASD ▶ TOF ▶ PDA ▶ bronchogenic cysts ▶ pulmonary sequestration • It is associated with large pleural defects (the lung can herniate and surround the intrapericardial vascular structures) RADIOLOGICAL FEATURES CXR/CT/MRI • Complete absence of the left pericardium: cardiac displacement into the left chest ▶ interposition of PERICARDITIS DEFINITION • Pericardial inflammation caused by: myocardial infarction (Dressler syndrome) ▶ mediastinal irradiation ▶ infection (viral or bacterial) ▶ connective tissue diseases (rheumatoid arthritis or SLE) ▶ metabolic disorders (uraemia or hypothyroidism) ▶ neoplasia ▶ AIDS CLINICAL PRESENTATION • Chest pain ▶ dyspnoea ▶ pericardial friction rub ▶ pulsus paradoxus RADIOLOGICAL FEATURES CXR Acute pericarditis commonly manifests as a pericardial effusion (which is usually diagnosed with echocardiography) • Pericardial effusion: a sudden increase in the cardiac silhouette without specific chamber enlargement ▶ filling in of the retrosternal space ▶ effacement of the normal cardiac borders ▶ a ‘water bottle’ cardiac configuration ▶ the bilateral ‘hilar overlay’ sign ▶ the ‘epicardial fat pad’ sign (with an anterior pericardial stripe > 2mm on a lateral CXR) CT Pericardial enhancement (increased attenuation suggests haemorrhage) 36 MRI In the absence of haemorrhage, effusions are predominantly low SI ▶ haemorrhagic effusions are of variable SI (depending upon the blood product age) • Inflammatory conditions: T2WI: thickened inflamed pericardium returns moderate to high SI ▶ T1WI þ Gad: enhancement PEARLS • Causes of a transudative pericardial effusion: cardiac surgery ▶ CCF ▶ uraemia ▶ myxoedema ▶ collagen vascular diseases • Causes of a haemopericardium: trauma ▶ aortic dissection or rupture ▶ neoplasm • Constrictive pericarditis: this represents a chronic phase of fibrous scarring, pericardial thickening and obliteration of the pericardial cavity ▶ it can result in restriction of diastolic cardiac filling § The aetiology is usually unknown (but is presumed secondary to an occult viral pericarditis) ▶ it can also be due to neoplastic infiltration or after mediastinal irradiation § CT/MRI Pericardial thickening !

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