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(BQ) Part 2 book Radiographic pathology for technologists presentation of content: Urinary system, central nervous system, hemopoietic system, reproductive system, endocrine system, traumatic disease.
CHAPTER 7 Urinary System LEARNING OBJECTIVES On completion of Chapter 7, the reader should be able to the following: • Describe the anatomic components of the urinary system and their functions • Discuss the role of other modalities in imaging the urinary system, particularly sonography and computed tomography • Discuss common congenital anomalies of the urinary system • Characterize a given condition as inflammatory or neoplastic • Identify the pathogenesis of the pathologies cited and the typical treatments for them • Describe, in general, the radiographic appearance of each of the given pathologies OUTLINE Anatomy and Physiology Imaging Considerations KUB Radiography Intravenous Urography Cystography Retrograde Pyelography Sonography Computed Tomography Renal Angiography Magnetic Resonance Imaging Interventional Procedures and Techniques Urinary Tubes and Catheters Congenital and Hereditary Diseases Number and Size Anomalies of the Kidney Fusion Anomalies of the Kidney Position Anomalies of the Kidney Renal Pelvis and Ureter Anomalies Lower Urinary Tract Anomalies Polycystic Kidney Disease Medullary Sponge Kidney Inflammatory Diseases Urinary Tract Infection Pyelonephritis Acute Glomerulonephritis Cystitis Urinary System Calcifications Degenerative Diseases Nephrosclerosis Renal Failure Hydronephrosis Neoplastic Diseases Renal Cysts Renal Cell Carcinoma Nephroblastoma (Wilms Tumor) Bladder Carcinoma KEY TERMS Acute glomerulonephritis Adenocarcinoma Bladder carcinoma Bladder diverticula Bladder trabeculae Bright disease Crossed ectopy Cryoablation 215 216 CHAPTER 7 Urinary System Cystitis Ectopic kidney Foley catheter Horseshoe kidney Hydronephrosis Hyperplasia Hypoplasia Malrotation Medullary sponge kidney Nephroblastoma Nephroptosis Nephrosclerosis Nephrostomy tube Neurogenic bladder Polycystic kidney disease Pyelonephritis Pyuria ANATOMY AND PHYSIOLOGY The urinary system consists of two kidneys, two ureters, a urinary bladder, and a urethra (Fig 7-1) The urinary system forms urine to remove waste from the bloodstream for excretion The kidneys are the site where urine is formed and excreted through the remarkable processes of filtration and reabsorption, involving up to 180 liters (L) of blood per day Urine formed by this process amounts to approximately to 1.5 L per day and passes from the kidneys to the bladder through the ureters Stored in the bladder, it is eventually excreted through the urethra The kidneys are retroperitoneal, normally located between the twelfth thoracic vertebra and the third lumbar vertebra The right kidney lies slightly lower because of the presence of the liver superiorly The notch located on the medial surface of each kidney is the hilus, the area where structures enter and leave the kidney These structures include the renal artery and vein, lymphatics, and a nerve plexus Microscopically, the nephron is the functional unit of the kidney responsible for forming and excreting urine (Fig 7-2) The nephron unit is composed of the Radiofrequency ablations Renal agenesis Renal calculi Renal colic Renal cyst Renal failure Staghorn calculus Supernumerary kidney Suprapubic catheter Uremia Ureteral diverticula Ureteral stents Ureterocele Urethral valves Urinary meatus Urinary tract infection Vesicoureteral reflux Right Adrenal glands Left Kidney Ureter Urinary bladder Urethra FIGURE 7-1 The urinary system glomerulus, Bowman capsule, and numerous convoluted tubules Blood flowing through the glomerulus, a ball-like cluster of specialized capillaries, is filtered and cleaned of impurities Fluid moves out of the glomerulus into Bowman capsules and through the various convoluted tubules, CHAPTER 7 Urinary System Afferent and efferent arterioles Glomerulus Proximal convoluted tubules Loop of Henle: - Descending limb -Ascending limb Renal arteries and veins Fibrous capsule Distal convoluted tubule Cortex 217 Renal column Renal pyramid Medulla Renal sinuses Minor calyx Bowman's capsule Major calyx Renal pelvis Collecting tubule Ureter FIGURE 7-3 The structure of a kidney Minor calyx FIGURE 7-2 The microscopic structure of a nephron Ureter Ureteral opening Trigone resulting in the production of urine The nephron unit terminates into a collecting tubule, which forms a tube opening at the renal papilla into a minor calyx Minor calyces terminate in the major calyces, which, in turn, terminate at the renal pelvis (Fig 7-3) The ureters extend from the kidneys to the urinary bladder and are approximately 10 inches in length (Fig 7-4) They normally enter the bladder obliquely in the posterolateral portion of the bladder, equidistant from the urethral orifice in a triangular fashion A number of variations of this exist The function of the ureters is to drain the urine from the kidneys to the bladder The bladder is located posterior to the symphysis pubis It serves as a reservoir for urine before urine is expelled from the body The bladder is very muscular and capable of distension Valves located at the junction of the ureters and bladder prevent the backflow of urine The urethra is a tube leading from the urinary bladder to the exterior of the body The female urethra is approximately to 11 inches in length, whereas the male urethra is approximately inches in length In men, the urethra passes through the prostate gland and also serves as a part of the reproductive system by receiving seminal fluid via the ejaculatory ducts, which open into the urethra from the prostate The Urethra Prostate gland R L FIGURE 7-4 An anterior cutaway view of the bladder male urethra is classified by three separate portions: (1) the prostatic portion, (2) the membranous portion, and (3) the cavernous portion The urethra opens to the exterior of the body via the urinary meatus IMAGING CONSIDERATIONS Urinary disorders may be suggested by abnormal laboratory or clinical findings Clinical findings include frequent urination, polyuria, oliguria, dysuria, or obstructive symptoms The urine may also have an abnormal color, resulting from a variety of factors Kidney pain is generally located in the flank or back around the level of the twelfth thoracic vertebra, whereas bladder pain resulting from cystitis is usually limited to the urinary bladder Patient renal function should be assessed before administering intravenous contrast agents in radiology The most common laboratory tests conducted include serum creatinine, blood urea nitrogen (BUN), and glomerular 218 CHAPTER 7 Urinary System filtration rate (GFR) In a normal adult, serum creatinine production and excretion are constant Creatinine is a waste product derived from a breakdown of a compound normally found in muscle tissue BUN levels are influenced by urine flow and the production and metabolism of urea BUN designates the ability of the urinary system to break down nitrogenous compounds from proteins to produce urea nitrogen Individuals with significant kidney function impairment often have raised blood levels of creatinine, urea nitrogen, or both because the glomerulus cannot adequately filter substances, the tubular system is not functioning properly, or both The GFR may be estimated (eGFR) by using the serum creatinine value in combination with the patient’s age, race, and gender Normally, the GFR should be 90 milliliters per minute per 1.73 meters cubed (mL/min/1.73 m2) or greater Intravenous contrast agents should not be used in patients with a BUN greater than 50 milligrams per deciliter (mg/dL) or a serum creatinine greater than 3 mg/dL The exact GFR threshold contraindicating the administration of intravenous (IV) contrast medium has not been established at this time KUB RADIOGRAPHY KUB (kidney, ureter, bladder) radiography is useful in demonstrating the size and location of the kidneys These organs may be visible radiographically because of the perirenal fat capsule that surrounds them The kidneys are generally well fixed to the abdominal wall and are seen to move with respiratory effort As mentioned earlier, the right kidney is usually located inferior to the left kidney because of the presence of the liver Men’s kidneys are generally larger than those of women The kidneys lie in an oblique plane within the abdomen and tend to parallel the borders of the psoas muscle shadows Evaluation of the kidneys using only a KUB image is limited because the kidney shadows may often be obscured by bowel content and are difficult to visualize because of the inherent low subject contrast in the abdomen However, KUB FIGURE 7-5 A preliminary or scout image before injec- tion of intravenous contrast for an intravenous urogram The image demonstrates the renal and psoas major muscle shadows radiography is the usual beginning for intravenous urography (IVU), sometimes referred to as intravenous pyelography (IVP) (Fig 7-5) In this case, its primary purposes are to (1) determine if adequate bowel preparation has been accomplished and (2) visualize radiopaque calculi of the KUB that may otherwise be hidden by the presence of contrast media The radiologist also examines areas unrelated to the urinary tract because they may hold clues to the diagnosis and may also assist in differentiating between gastrointestinal (GI) and genitourinary disorders Intravenous Urography One procedure used to assess the urinary system is the IVU (or IVP) The indications for performing IVU include suspected urinary tract obstruction, abnormal urinary sediment (especially hematuria), systemic hypertension, or, frequently in men, symptoms of prostatism Although few serious adverse effects typically accompany the injection of urographic contrast agents, current research indicates an increased risk of mortality in white female older adults because of renal failure and anaphylaxis The risk of adverse reactions to an iodinated contrast agent increases because of a variety of factors, including a history of previous contrast reactions; asthma or other allergies; heart disease; dehydration; preexisting kidney disease; treatment with β-blockers, NSAIDs, or interleukin-2 (IL-2); a history of other pathologic diseases such as sickle cell anemia, polycythemia, and myeloma; or all of these factors The use of nonionic, low-osmolar contrast agents significantly reduces minor and moderate reactions These contrast agents still contain iodine, but the molecular makeup prevents them from disassociating into ions (nonionic) in the bloodstream, thus reducing the risk of an anaphylactic reaction Visualization of the urinary system depends on the concentration of contrast material filtered by the kidneys and present in the collecting system; therefore, the patient must have fairly normal physiologic function for diagnostic images to be obtained Other imaging techniques such as sonography and computed tomography (CT) should be considered in patients with compromised renal function Many IVU routines allow for an image to be taken within 30 seconds to minute after contrast medium injection Because the contrast agents for most IVU examinations are injected by hand, the timing generally begins on completion of the bolus injection and will vary from institution to institution This is termed the nephrogram phase and may be used to demonstrate the contrast agent in the nephrons before it reaches the renal calyces Ready visualization of the renal parenchyma allows for an inspection of the renal outline Indentations or bulges may indicate the presence of disease The nephrogram image is also used to check for normal kidney position, which may be altered by congenital malposition, ptosis, or the presence of a retroperitoneal mass Although the numbers and types of images obtained may vary from one institution to CHAPTER 7 Urinary System 219 FIGURE 7-6 A 15-minute postinjection image during intravenous urography demonstrating the normal collecting system another, a series of collecting system sequence images are the final part of IVU (Fig 7-6) The renal pelvis, calyces, ureters, and bladder are examined for any abnormalities The calyces should be evenly distributed and reasonably symmetric Usually, they appear as buttercup-shaped projections surrounding the renal papillae Calyceal dilatation may be demonstrated as a result of acute or chronic urinary tract obstruction, obstructive uropathy, or reflux Dilatation secondary to destruction of the renal pyramids is less common Because of the peristaltic activity of ureters, only part of their length in a collecting system sequence may be demonstrated (Fig 7-7) Nonopaque ureteral calculi sometimes cause filling defects and an obstructive dilatation of the ureter The majority of all urinary tract calculi are found at the vesicoureteral junction Any pronounced deviation of the ureter suggests the presence of a retroperitoneal mass Various filling defects may be demonstrated in the contrast agent–filled 220 CHAPTER 7 Urinary System FIGURE 7-7 A right posterior oblique projection after contrast injection for intravenous urography demonstrating the correct entrance of the ureters into the posterior bladder wall FIGURE 7-8 A postvoid image after an intravenous urography examination ureter during IVU, including tumors, blood clots, and nonopaque calculi Common bladder defects visualized during IVU include urinary catheter balloons, normal uterus and colon, and extrinsic deformities such as uterine or sigmoid colon tumors A “postvoid” image usually completes an IVU procedure and allows assessment of the bladder function (Fig 7-8) Cystography Cystography is a common radiographic examination for studying the lower urinary tract This involves insertion of a urinary catheter into the urethra and retrograde filling of the bladder with iodinated water-soluble contrast material (Fig 7-9) A frequent indication for this procedure is to identify vesicoureteral reflux (VUR) In the normal bladder, increased pressure as the bladder fills effectively shuts down any chance of reflux Bladder infection, however, may render FIGURE 7-9 A normal cystogram without reflux as seen in this oblique projection of the bladder in a 56-year-old woman the ureteral “valve” incompetent, refluxing the infection into the kidney Cystography may also be used to study congenital bladder anomalies, tumors, diverticula (Fig 7-10), calculi, bladder rupture, or neurogenic bladder Voiding CHAPTER 7 Urinary System 221 (micturition) cystography is sometimes used in conjunction with retrograde cystography to allow study of the urethra on voiding Urethrography may be accomplished using the antegrade approach, as with voiding cystourethrography, or retrograde when cystography is not necessary The antegrade approach is used to study the posterior urethra, especially in the male patient, and the retrograde approach is helpful in studying the anterior urethra (Fig 7-11) The usual intent of voiding cystography is to allow study of a urethral stricture (Fig 7-12) Retrograde Pyelography FIGURE 7-10 Bladder diverticula in an 88-year-old man FIGURE 7-12 A voiding cystourethrogram demonstrates demonstrate the presence of numerous calculi within them Retrograde pyelography requires the placement of a catheter into the ureteric orifice in a retrograde fashion This is usually performed by a urologist during cystoscopy to allow injection of contrast medium directly into the urinary tract to outline the renal collecting system The approach is termed retrograde because the contrast agent is injected through the ureter into the affected kidney, opposite the normal direction of urine flow Indications for this study may include a urethral diverticula The mucosal margin of the prostatic urethra is ragged as a result of scarring after transurethral resection FIGURE 7-11 Retrograde urethrography procedure demonstrating a urethral stricture in a male patient The location of the stricture is confirmed by its consistent appearance on all three images 222 CHAPTER 7 Urinary System FIGURE 7-13 A sonogram demonstrating a renal stone in the cortex of the kidney hematuria of unknown cause, hydronephrosis, and, in cases of a nonfunctioning kidney, the determination of further information about possible obstruction Sonography Sonography is a noninvasive method of imaging both functioning and nonfunctioning kidneys Because sonography can clearly demonstrate the parenchymal structure of the kidney and the renal pelvis without the use of contrast agents, it is becoming the primary method of visualizing the kidneys and evaluating most renal disorders It is useful in evaluating kidney stones (Fig 7-13), calcifications, hydronephrosis (Fig 7-14), abscesses, renal masses, and renal cysts and to assess renal size, atrophy, or both Sonography is the modality of choice for evaluating individuals after kidney transplantation Doppler techniques are helpful in assessing blood flow in the renal arteries and veins for both transplant recipients and individuals with suspected renal artery stenosis Sonography is also used to visualize abnormalities of the urinary system present in the fetus Computed Tomography CT is an excellent modality for imaging the kidneys because it can detect small differences in tissue densities within the body Kidneys can be FIGURE 7-14 A sonogram confirming hydronephrosis of the kidney and proper placement of a ureteral stent to assist in allowing the kidney to drain properly into the urinary bladder visualized on CT with or without the use of a contrast agent Abdominal CT is particularly important in determining the nature of renal masses, either solid or cystic, which may not be visible on a KUB radiograph because of the presence of gas in the bowel CT evaluation of the urinary system generally requires the use of an IV contrast agent to differentiate renal cysts from solid masses and to evaluate the extent of the lesion (Fig 7-15) Because most institutions use an automatic injector in CT, scanning may begin when the bolus of contrast medium is injected or shortly after injection, and a delay is programmed into the scanner to allow the contrast medium to reach the bladder before the pelvis is imaged CHAPTER 7 Urinary System 223 FIGURE 7-15 A computed tomography image of a FIGURE 7-16 A computed tomography image demon- CT is also useful for looking for sites of obstruction caused by renal calculi or retroperitoneal masses, which may distort the urinary tract; assessing renal infection or trauma; and staging tumors of the lymph nodes A CT renal stone study is considered the imaging modality of choice by the American College of Radiology (ACR) when patients present with an acute onset of flank pain or other symptoms suggest the presence of renal calculi Because CT displays excellent contrast resolution, stones are identified more easily than with conventional radiography, but without the use of an intravenous contrast agent (Fig 7-16) In addition, pelvic CT is the imaging modality of choice for the evaluation of bladder tumors or masses renal artery stenosis that may cause hypertension, as well as to assess other vascular disorders such as aneurysms or congenital anomalies It is also performed on kidney donors before surgical removal of the kidney to serve as a “road map” of vascular anatomy for the surgeon In renal angiography, a catheter is introduced peripherally, most commonly into the femoral artery The catheter tip may be placed into the specific renal artery of interest or into the abdominal aorta just superior to the renal arteries The contrast agent is injected via the catheter to image the vasculature of the kidney or kidneys complex cystic structure of the left kidney after contrast injection during the nephrogram phase Renal Angiography Renal angiography is one of the most invasive imaging procedures performed on the urinary system It is usually indicated to further evaluate a renal mass suspected of being malignant, to embolize blood flow to a renal mass, or to assess strating a calcification in the left kidney indicative of a renal stone without the use of a contrast agent Magnetic Resonance Imaging The role of magnetic resonance imaging (MRI) has greatly improved as a result of breath-hold imaging sequences and bolus injections of gadolinium contrast agents Abdominal MRI is useful in follow-up studies in patients with known renal cell carcinoma or invasive bladder cancers and adrenal masses Additionally, magnetic resonance angiography (MRA) is now highly recommended 224 CHAPTER 7 Urinary System by the ACR in the diagnosis of renovascular hypertension (Fig 7-17) Contrast-enhanced three-dimensional MRA obtains coronal images of the renal arteries in as little as 20 seconds The images can then be rotated for better visualization MRA is also an excellent modality for demonstrating other vascular anomalies such as thrombosis, aneurysms, and arteriovenous malformations (AVMs) Because it allows for imaging of the urinary system in all three planes, it is also used in conjunction with CT for the evaluation of renal masses and their extensions In cases of renal cyst evaluation, MRI is capable of differentiating between fluid accumulation from hemorrhage and infection Pelvic MRI is used to readily demonstrate the seminal vesicles and prostate gland in men as well as masses within the urinary bladder Because of its ability to clearly image soft tissue, pelvic MRI allows thorough evaluation of invasive cancers within the urinary bladder FIGURE 7-17 A contrast-enhanced three-dimensional magnetic resonance angiography image of the renal arteries demonstrating normal renal artery patency Interventional Procedures and Techniques Percutaneous nephrostography is an antegrade study in which the contrast medium is injected directly into the renal pelvis It involves posterolateral insertion of a needle or catheter into the renal pelvis using medical sonography, fluoroscopy, or sometimes a combination of both modalities (Fig 7-18) The nephrostomy tube may be left in place to provide drainage of an obstructed kidney or to allow retrieval of the calculus with a basket catheter Sometimes the procedure is used to relieve obstruction in patients for whom immediate surgery is not possible Extracorporeal shock wave lithotripsy (SWL) is a method used to locate and treat renal calculi After the location of the stone is determined radiographically, fluoroscopy or sonography aids in alignment of a high-frequency shock wave directed at the stone If the treatment is successful, the stone disintegrates into fragments and is excreted via urination, thus helping the patient avoid surgery and a much lengthier recovery period (Fig 7-19) FIGURE 7-18 Placement of a right percutaneous renal drainage tube under fluoroscopic guidance 444 INDEX Hepatoma (hepatocellular carcinoma), 209–210 Hepatomegaly, 199–200 demonstration, 204 Hepatopancreatic ampulla (ampulla of Vater), 194 Hereditary anomalies, abdomen/ gastrointestinal system, 150–158 Hereditary breast ovarian cancer syndrome, 322 Hereditary disease, 10–11 cardiovascular system, 112–118 causes, 11 central nervous system, 261–265 hemopoietic system, 298–300 respiratory system, 74–76 skeletal system, 24–31 urinary system, 227–232 Hereditary nonpolyposis colorectal cancer (HNPCC), 187 Hernia anterior abdominal hernia, CT demonstration, 171f entrapment, 174–175 hiatal hernia, 170–173 incarcerated hernia, 170 left inguinal hernia, CT image, 170f paraesophageal hiatal hernia, fundus (narrowing), 174f sliding hiatal hernia, esophagus (narrowing), 172f strangulated hernia, 170 Herniated nucleus pulposus, 268–270 Herniation, 170 illustration, 175f Heterogeneous calcified plaque, Doppler sonogram, 104f Hiatal hernia, 170–173 types, 173 Hickman catheter, access catheter, 71–72 High-density lipoprotein (HDL), decrease, 121 High-resolution CT (HRCT) thin section cuts, usage, 82–83 usage, 79–80 High sensitivity cross-reactive protein (hs-CRP) test, 123–124 Hills-Sach deformity, 399–400 Hips capital femoral epiphysis, slip anteroposterior pelvic radiograph, 388f postsurgical intervention, radiograph, 389f developmental dysplasia, 28–29 femoral head/neck, destruction (radiograph), 34f left hip, congenital dislocation (frog leg lateral projection), 29f metastatic disease, anteroposterior radiograph, 54f osteoid osteoma, anteroposterior radiograph, 49f Hips (Continued) prosthetic replacement, radiograph, 36f traumatic dislocation, 400 Hirschsprung disease (congenital aganglionic megacolon), 156 infant, rectosigmoid/large bowel distension, barium enema, 157f Histoplasma capsulatum infection, 85–86 Histoplasmosis, 85–86 acquisition, 86 chronic cavitary histoplasmosis, 85–86 posteroanterior chest radiograph, 86f progressive disseminated histoplasmosis, 85–86 Hodgkin lymphoma, 303–304 nodal distribution, 304 signs/symptoms, 304 Homeostasis, fluid balance, 13 Horizontal fracture, 396–398 Hormonal stimuli, 337 Hormone replacement therapy (HRT), usage, 347–348 Hormones, secretion, 337 Horseshoe kidney, 228 obstruction, CT scan, 229f Hospital-acquired nosocomial disease, prevention, 2–3 Host tissue, CD4 receptors/chemokine co-receptors (presence), 297f Housemaid’s knee, 39–41 Human genetic technology, 8–9 Human Genome Project, DNA sequence identification, genome sequence determination, Human immunodeficiency virus (HIV) infection, 85 AIDS-defining opportunistic infections/ neoplasms, 296b signs/symptoms, 296–297 tissue distribution, 297f Human leukocyte antigen HLA (HLA-B27) test, 37 Humeral head, anterior dislocation (anterorposterior/oblique/transscapular projections), 401f Humeral neck fracture, motor vehicle accident (anteroposterior projection), 376f Humerus anteroposterior radiograph, 47f bone cyst, pathologic fracture (radiograph), 385f spiral fracture, radiograph, 384f transverse fracture, anteroposterior projection, 385f twisting injury, radiograph, 384f Humoral stimuli, 337 Hurst dilator, usage, 159 Hyaline membrane disease, 75–76 Hydatidiform mole, 327–328 Hydrocele, 332 visualization, 332f Hydrocephalic brain, comparison, 264f Hydrocephalus, 263–265 CSF accumulation, excess, 263 visualization, CT/MRI (usage), 264–265 Hydronephrosis, 240–241 gross bilateral hydronephrosis, 240f right kidney, 240f sonogram, 222f, 240f Hyperactive hot nodule, nuclear medicine 123 iodine thyroid uptake scan, 352f Hypercapnia, 73–74 Hyperextension-flexion injuries, 41 Hyperinflation, posteroanterior chest radiograph, 83f Hypermetabolic activity, 146f Hypermetabolic basal ganglia, blood shunting (PET scan axial image), 260f Hypermetabolic focal activity, 147f Hyperostosis frontalis interna, 46 Hyperparathy, 353 Hyperparathyroidism, 353–355 nuclear medicine scan, 354f types, 353 Hyperplasia, 9–10, 228 Hypertension impact, 121 pulmonary artery, 121 Hyperthyroidism, 339–340 Graves disease, impact, 351 Hypertrophic pyloric stenosis (HPS), 152–155 indication, barium (flow), 154f sonography, usage, 153–155 Hypertrophy, 9–10 Hypoechogenic solid breast mass, sonogram, 323f Hypogastric region, 135 Hypoglycemia, impact, 338–339 Hypopitiuitarism, 347 Hypoplasia, 228 Hypothalamus, 337 connection, 337–338 pathology demonstration, MRI usage (ACR recommendation), 341 Hypothyroidism, 339–340, 351 Hypoventilation, 73–74 Hypoxemia, 73–74 Hysterosalpingogram, contrast medium (free spillage), 310f Hysterosalpingography (HSG), 310–311 SHG replacement, 310–311 I Iatrogenic reactions, 2–3 Idiopathic, term (usage), 2–3 Ileocecal junction, radiograph, 141f Ileostomy, 142 Ileum, congenital discontinuation, 151–152 Iliac arteries, 137–138 Ilium, multiple fractures, 362f Impacted fracture, 379 Imperforate anus, 152 demonstration, spot image, 154f illustration, 154f Incarcerated hernia, 170 internal inguinal ring, obstruction, 171f Incidence, Incomplete fracture, 386–387 occurrence, 387 Infants deaths, 325 double bubble sign, 153f mediastinum, appearance, 64–65 parietal bone, linear skull fracture (lateral skull radiograph), 367f premature delivery, 325 rectosigmoid/large bowel distension (barium enema), 157f surgically repaired meningomyelocele, T1-weighted MRI view, 263f tetralogy of Fallot, chest radiograph, 118f Infarct axial image, PET scan, 260f occurrence, 124–125 Infarction, pregnancy (impact), 347 Infection, inflammatory process, 12–13 Infectious arthritis, 34–35 Inferior vena cava (IVC) Greenfield filter placement, anteroposterior abdominal radiograph, 113f venous blood flow, 193 Inferior vena cavogram (demonstration), carbon dioxide (contrast medium function), 114f Inflammatory bowel disease (IBD), 141 chronic IBD, 163 Inflammatory disease, 10–13, 31–41, 76–79 abdomen, 158–168 central nervous system, 265–268 female reproductive system, 315–316 gastrointestinal system, 158–168 hepatobiliary system, 199–208 reproductive system, 315–316 urinary system, 232–236 Inflammatory reaction, 11 Infrarenal abdominal aortic aneurysm, contrast-enhanced CT image, 128f Inguinal lymph nodes, enlargement (pelvic CT scan), 304f Inherited diseases, types, 11 Injury, impact, 358 Inspiration chest radiograph, 101 level, posteroanterior chest radiograph, 101f Insufficiency fractures, 389–390 Intermediate autosomal osteopetrosis (IAO), 26–27 Intermediate lobe, 337–338 Internal carotid artery (ICA) arterial flow, Doppler effect, 104f atherosclerosis, Doppler sonogram, 124f Doppler sonogram, 104f echo signal, absence, 124f spectrum abnormality, heterogeneous calcified plaque (Doppler sonogram), 104f stenosis, 272–273 INDEX Internal os, 308–309 sagittal sonographic view, 327f Interstitial pneumonia, 76 viral pneumonia, 79 Intertrochanteric fracture, pelvis (anteroposterior projection), 381f Intervertebral disks CT myelogram, 44f illustration, 253f spaces, visibility, 62 Intestinal rotation, aberrations, 155 Intima (inner layer), 100 Intraaortic balloon pump (IABP) catheter, 71–72 placement, portable anteroposterior chest radiograph, 73f Intraarterial thrombolysis, usage, 260–261 Intracerebral brain hematoma, 373f Intracerebral brain hemorrhage, 275 Intracerebral hematoma, 371 Intracranial blood flow (absence), brain death (radionuclide brain scan), 260f Intracranial pressure (ICP), increase, 253–254 convolutional markings, result, 31f Intracranial tumors, sites, 276f Intraluminal neoplasms, abnormalities, 141 Intraperitoneal air, 409–410 Intrathoracic stomach, 175f Intravenous contrast media (bolus), contrast enhanced CT tracking, 68f Intravenous pyelography (IVP), 218 usage, 361 Intravenous urogram, postvoid image, 220f Intravenous urography (IVU), 218–220 routines, 219 usage, 361 Intussusception, 175f coiled spring appearance, 175–176 occurrence, 175–176 pediatric barium enema, 176f Invasion, 14–16 Involucrum, 32 sagittal MRI scan, 33f Involutional change, 309–310 Iodine-131 (131-I)-metaiodobenzylbuanidine (MIBG), usage, 342 Ionizing radiation, effects, 13 Ischemia, occurrence, 121–123 Ischemic necrosis, 124–125 Ischemic strokes, 272–275 Islets of Langerhans, 194, 340–341 Isthmus, traumatic aortic injury (CT scan), 405f J Jaundice, 208 medical (nonobstructive) jaundice, 208 sonographic examination, 208 surgical (obstructive) jaundice, 208 Jefferson fracture (burst fracture), 363 445 Joints associated structures, inflammation, 39–41 bimalleolar fracture, ankle radiographs, 393f–394f dislocation, 399 ankle radiographs, 393f–394f effusions, demonstration, 34 infection, routes, 31f inflammation (arthritis), 33–34 metacarpophalangeal/interphalangeal joints, synovitis (MRI scan), 23f osteoarthritis, impact, 38–39 sacroiliac joints, impact, 34 space (narrowing), cortical erosion (impact), 35–37 types, 22 Jugular vein, injection sites, 71 Juvenile fibroadenoma, sonographic image, 321f Juvenile rheumatoid arthritis (JRA), 37 diagnosis, ACR criterion, 37 types, 37 Juxtaarticular erosions, presence, 22–23 K Kaposi sarcoma, 185, 298 chest radiograph, 299f Kempe, Henry, 400–402 Kidneys atrophic right kidney, abdominal CT image, 228f calculi, presence (ultrasonogram), 237f cortex, renal stone (sonogram), 222f CT imaging, 222 echogenic texture, diagnostic medical sonogram, 235f ectopic kidney, urogram, 230f fusion anomalies, 228–229 horseshoe kidney, obstruction (CT scan), 229f hydronephrosis, sonogram, 222f, 240f left kidney calcification, CT image, 223f cystic structure, CT image, 223f malrotation, 229 number/size anomalies, 227–228 position anomalies, 229 prolapse, 229 recurrent/persistent infection, 234–235 renal hypoplasia, vasculature, 228f right kidney, fracture (intravenous urogram), 409f shadows, demonstration, 139f transplantation, pelvic computed tomography, 239f Kidney stones, 238f Kidney, ureter, bladder (KUB) radiography, 218–227 Killian-Jamieson diverticulum, 179 K lymphocytes, aggregation, 157 Knees benign osteoclastoma, lateral radiograph, 50f 446 INDEX Knees (Continued) fusion, chronic osteomyelitis, 33f joints, osteochondroma (bilateral anteroposterior radiograph), 46f left knee, gunshot wound (radiograph), 378f posteroanterior projection, radiograph, 52f prosthesis, dislocation (anteroposterior projection), 400f right knee rotary injury, MRI scan, 390f tumor demonstration, anteroposterior radiograph, 51f Kyphotic deformity (dowager’s hump), 343 L L1-L4 fusion, anteroposterior lumbar spine radiograph, 255f L4 lesions, T2-weighted sagittal MRI view, 295f Lactase insufficiency, indication, 158f Lacunar infarction, 273–274 Large-bolus intravenous (IV) iodinated contrast media injections, usage, 197 Large bowel, 137–138 abnormalities, 141 distension, barium enema, 157f obstruction, 173t radiography, 141–142 Large venous thrombus, transverse view, 105f Larsen syndrome, 28–29 Lateral elbow, positive anterior fat pad sign, 396f Lateral femoral condyle, nonunion (knee radiograph), 378f Lateral meniscocondylar notch, bone bruising (MRI scan), 390f Lateral ventricles, lateral/superior views, 251f Left adrenal gland, bronchogenic carcinoma (metastasis), 93f Left ankle, Maisonneuve fracture (radiographs), 395f Left anterior descending artery coronary artery, bifurcation, 126f right anterior oblique projection, coronary angiography, 125f soft plaque (demonstration), multislice computed tomography (usage), 123f Left atrium, 98 oxygenated blood, return, 117 Left brachiocephalic vein, catheterization/ angiography, 112f Left breast sagittal T2-weighted fat-suppressed MRI scan, 314f stellate mass, mammogram, 324f Left common iliac artery, aneurysm (angiographic display), 111f Left coronary artery, bifurcation, 126f Left femoral epiphysis (low signal intensity), Legg-Calvé-Perthes disease (MRI scan), 404f Left femoral head, Legg-Calvé-Perthes disease (anteroposterior pelvic radiograph), 404f Left femur, MRI, 51f Left hip congenital dislocation, frog leg lateral projection, 29f trauma, radiograph, 380f Left hypochondriac region, 135 Left iliac region, 135 Left inguinal hernia, CT image, 170f Left kidney agenesis, intravenous urogram, 227f calcification, CT image, 223f cystic structure, CT image, 223f metastatic lesion, computed tomography, 242f renal cyst, T2 TruFisp weighted MRI scan, 241f Left lateral decubitus abdomen, free air (demonstration), 139f Left lateral decubitus chest, free pleural fluid layering (presence), 88f Left lateral decubitus posteroanterior projection, air contrast barium enema (demonstration), 142f Left lateral ventricle, ring lesion (T1-weighted coronal MRI view), 266f Left leg pain, Ewing sarcoma (radiographs), 53f Left lower extremity, venogram, 130f Left lower lobe infiltrate, posteroanterior/left lateral chest radiographs, 299f Left-lower quadrant (LLQ), 135 Left lumbar region, 135 Left maxillary sinus, air-fluid level (presence), 90f Left parietal lobe, infarct (axial FLAIR MRI scan), 272f Left pelvis, transplanted kidney (pelvic computed tomography), 239f Left pterygoid plate, fracture (3-D CT reconstructions), 398f Left-sided appendicitis, 179–182 Left-sided failure (CHF), 120–121 Left subclavian vein, central venous catheter (entry), 72f Left subclavicular region, esophagitis/pain, 80f Left testicle, uptake (increase), 332f Left upper lobe, tuberculosis, 80f Left-upper quadrant (LUQ), 135 Left ureteral reflux, intravenous urography, 236f Left ureteric diverticula, double densities (intravenous urogram), 231f Left ureter, retrograde pyelogram, 229f Left ventricle, 98 blood, pumping (problem), 120–121 contraction, comparison, 114 Left ventricular configuration, posteroanterior chest radiograph, 124f Legg-Calvé-Perthes disease, 403–404 left femoral epiphysis, low signal intensity (MRI scan), 404f left femoral head, anteroposterior pelvic radiograph, 404f Legionella pneumophila infection, 76 causative bacterium, impact, 78 Legionnaire’s disease, 78f bacterial pneumonia, impact, 78 Leiomyomas, 183 uterine fibroids, 319–320 Lesion, term (usage), 16 Leukemia, 16, 301–303 classification, 302 signs/symptoms, 302 Leukocytes, 291 classification, 292 Levacuator tube, usage, 148–149 Level III trauma centers, 359–360 Level II trauma centers, 359–360 Level I trauma centers, 359–360 Levin tube surgical placement, 149–150 usage, 148–149 Li-Fraumeni syndrome, 50 Ligament of Treitz, 137, 141, 155–156 Linear fractures, 366 Live fetus, ectopic location (transvaginal sonographic image), 326f Liver, 193 alcohol-induced liver disease, 199–200 arterial circulation, demonstration, 198f bronchogenic carcinoma, metastatic spread (CT scan), 210f cellular damage, 199–200 cirrhosis computed tomography scan, 201f identification, diagnostic medical sonography, 202 transjugular intrahepatic portosystemic stent procedure, catheter (usage), 111f dome, free air (demonstration), 139f decubitus abdominal radiograph, 408f fatty liver disease, 200 hemangioma, axial MRI slice, 209f heterogeneous lesion, hepatoma (relationship), 210f intravenous contrast (bolus injection), three-phase CT (usage), 198f lacerations, computed tomography, 199f lesions, identification, 203 local recurrence/metastases, 211f metastatic disease, hypermetabolic activity (PET demonstration), 146f metastatic liver disease, 210–211 metastatic liver lesions, commonness, 210 necrosis, 199–200 needle biopsy, computed tomography, 199f Liver (Continued) nonalcoholic fatty liver disease (NAFLD), 205 oxygenated blood, usage, 193 percutaneous liver biopsy, 205 portal venous flow, delayed images, 198f shadow, demonstration, 139f superior portion, metastatic lesion, 184f texture, 209 three-phase CT, 198f Lobar pneumonia, 76 Long bones Ewing sarcoma, 52–53 worm-eaten appearance, 32–33 Looser zones (pseudofractures), 343–344 Lordosis, loss, 362 Lover’s heel, 34 Low-density lipoprotein (LDL) increase, 121 oxidation, 121–123 Lower abdomen, demonstration, 136f Lower chest, lymph nodes (CT), 294f Lower extremities (bowing), tibia-fibula radiograph, 26f Lower GI tract, examination, 141 Lower left lung, empyema (drainage), 77f Lower lumbar spine, degenerative joint disease (anteroposterior projection), 269f Lower lumbar vertebrae, spina bifida occulta (abdominal radiograph), 30f Lower lung fields, obscuration, 61f Lower urinary tract anomalies, 230–231 Lumbar spine anteroposterior projection, 269f bone mass density, 345f reconstruction, sagittal plane MRI, 44f spondylolisthesis, sagittal reconstruction, 43f spondylosis, oblique radiograph, 44f transverse processes, demonstration, 139f Lumbar vertebral column, degenerative disk disease (sagittal MRI), 269f Lumbosacral spine, ependymoma (T1-weighted sagittal MRI view), 280f Lumen, 100 distortion, CT scan, 184f Lungs abscess, 86–87 treatment, 87 bilateral lung bronchiectasis, highresolution CT scan, 80f bronchiectatic changes, CT scan, 79f cancers, categories, 90–91 capillary-alveolar level, gas exchange, 99–100 embolism, CT scan demonstration, 68f hyperinflation, chest radiography, 82 malignancy, spread (routes), 93–94 right lung mass, CT-assisted core biopsy, 68f stab wound, tension pneumothorax, 406f INDEX Lungs (Continued) right upper lobe, traumatic pneumothorax/atelectasis (anteroposterior chest image), 405f transplantation, usage, 84 volume, increase, 75f Luteinizing hormone (LH), secretion, 337–338 Lymphatic spread, 14–16 Lymphatic system, 293 Lymph nodes, 293 Lymphocytes, 293 Lymphocytic leukemias, 302 Lymphoma, 16 Lymph, term (usage), 293 Lytic disease process, M Magnetic resonance angiography (MRA), 107 breath-hold imaging, 144 contrast-enhanced MRA, 107 endocrine system, 341 female reproductive system, 312–314 reproductive system, 312–314 usage, 255 Magnetic resonance cholangiopancreatography (MRCP), 197–198 Magnetic resonance colonography (MRC) techniques, benefits, 188–189 Magnetic resonance enterography (MRE), 144–145 sequences, 144–145 Magnetic resonance imaging (MRI) abdomen, 144–145 cardiovascular system, 107 central nervous system, 255–258 gastrointestinal system, 144–145 hepatobiliary system, 197–199 scan, 23f examples, 23f urinary system, 223–224 usage, 23 Maisonneuve fracture, 374–375, 392–393 left ankle, radiographs, 395f Male pelvis, coronal T2-weighted MRI scan, 329f Male reproductive system, 328–334 anatomy/physiology, 328 congenital anomalies, 329 cryptorchidism, 329 illustration, 328f imaging considerations, 328–329 neoplastic diseases, 329–334 pathology, summary, 334b prostate, carcinoma, 330–331 prostatic hyperplasia, 329–330 testicular masses, 331–334 Male urinary bladder, anterior cut away, 329f Malignant bone tumors, staging system, 45 447 Malignant neoplasia, 14 death cause ranking, 4–6 Malignant osteoclastoma, 49–50 Malignant testicular tumors, 332 Malignant tumors, nomenclature/ classification, 15t Maloney dilator, usage, 159 Malrotation abdomen, 155–156 bowel, 155f diagnosis, sonography (usage), 156 gastrointestinal system, 155–156 kidneys, 229 stomach, 175f Malunion, 377 Mammography, 311–312 usage, 311 value, 311 Mandibular fracture, 396 posteroanterior/anteroposterior axial/ Towne method projections, 398f Manifestations, Marble bone, 26–27 March fracture, 389–390 Marie-Strümpell disease (ankylosing spondylitis), 37 Mastalgia, 309–310 Master endocrine gland, 337–338 Mastitis, 316 Staphylococcus aureus infection, impact, 316 Maxilla fractures, 396–398 horizontal fracture (LeFort I), 396–398 Maxillary sinuses, bilateral mucosal thickening, 90f Maxillofacial bones, face trauma (axial/ coronal CT examinations), 397f Mechanical bowel obstruction, 173–177 abdominal radiograph, 175f Cantor tube, radiographic appearance, 150f Mechanical positive pressure ventilator (mechanical PPV), usage, 74 Meckel diverticulum, 156–157 Meckel scans, usage, 146 Media (middle layer), 100 Mediastinal emphysema (pneumomediastinum) occurrence, 65 portable pediatric anteroposterior chest radiograph, 66f Mediastinal hematoma, enlargement (CT scan), 405f Mediastinal structure, penetration (radiographic importance), 102 Mediastinum, 63–67 division, 59 endotracheal (ET) tube placement, 71f esophagus, relationship, 137f radiographic division, 64 sagittal view, 65f sail sign, 64–65 448 INDEX Mediastinum (Continued) widening, thoracic aortic aneurysm (posteroanterior chest radiograph), 129f Medicaid, funding, 6–7 Medical jaundice (nonobstructive jaundice), 195, 208 Medicare, health care funding source, 6–7 Medullary canal, 20–21 Medullary sponge kidney, 232 bilateral papillae/tubule dilation, 233f Medullary thyroid gland, 351–353 Medulloblastoma, 278–279 Melanocyte-stimulating hormone (MSH), secretion, 337–338 Melatonin, release, 338 Meningeal spaces, coronal perspective, 251f Meninges, coronal perspective, 251f Meningiomas, 279–281 primary spinal neoplasms, 285 surgical removal, 281 T1-weighted sagittal MRI view, 287f Meningitis, 265–266 Meningocele, 261–263 Meningomyelocele (spina bifida), 261–263 T1-weighted axial MRI view, 262f Mesentery, demonstration, 136f Metabolic disease, 10, 13 Metabolic syndrome, 350 Metacarpophalangeal/interphalangeal joints, synovitis (MRI scan), 23f Metaphysis, 21–22, 45–46 Metaplasia, definition, 9–10 Metastasis (metastases), 14–16, 53–55 central nervous system, 285 detection, 53–54 renal cell carcinoma, T1-weighted axial MRI view, 287f sites, 93–94 Metastatic bone cancer, primary sites, 55 Metastatic disease bone scan demonstration, 25f, 54f hypermetabolic activity, 146f Metastatic lesion, computed tomography, 242f Metastatic liver disease, 210–211 sonography, usage, 210 treatment, 210–211 Metastatic liver lesions, commonness, 210 Metastatic spread CT scan, 210f occurrence, 14–16 Methotrexate, usage, 35–37 Middle cerebral artery, infarct (unenhanced CT scan), 273f–274f Middle mediastinal masses, origin, 64 Middle meningeal artery, appearance (lateral skull radiograph), 253f Miliary tuberculosis, 81 hematogenous spread, 81f Miller-Abbott tube, usage, 149 Mineralocorticosteroids, 338–339 Mitral regurgitation, hemodynamic effect, 119f Mitral stenosis hemodynamic effect, 119f radiographic manifestations, 119 Mitral valve prolapse, 119 M-mode echocardiography, 103 Molar tissue, sagittal sonographic image, 328f Monocytic leukemias, 302 Monteggia fracture, 391–392 Morbidity rate, Morphology, Mortality rates definition, fluctuation, Motor vehicle accident (MVA) airbags/seatbelts, effectiveness, 361–362 ankle, Pott fracture (anteroposterior/ lateral projections), 393f–394f bilateral zygomatic arch fracture, 3-D CT reconstruction, 398f epidural hematoma, noncontrast axial CT view, 371f forearm, fractures (radiograph), 385f humeral neck fracture, anteroposterior projection, 376f humerus, transverse fracture (anteroposterior projection), 385f injuries, reduction, 406–408 lateral cervical spine radiograph, 363f right femoral head, posterior dislocation (pelvic radiograph), 402f right maxillary sinus, comminuted fracture, 3-D CT reconstruction, 398f spleen (rupture), blunt trauma (axial CT images), 408f traumatic diaphragmatic hernia, chest radiograph, 409f trauma victim (anteroposterior pelvic view), 362f M protein production, 300–301 Mucosa, inflammation, 167 Multidetector CT (MDCT) units, usage, 106–107 usage, 360–361 Multiple fractures, 381–384 motor vehicle accident trauma victim, anteroposterior pelvic view, 362f Multiple gate acquisition scans (MUGA), 106 Multiple hereditary exostoses (MHE), 45–46 Multiple myeloma, 44, 300–301 humerus radiograph, 301f L4 destruction, T2-weighted sagittal MRI view, 295f lateral skull radiographs, 301f treatment, thalidomide drugs (usage), 301 Multiple pregnancies, 325 Multiple sclerosis (MS), 270–272 axial fluid-attenuated inversion recovery (axial FLAIR) MRI scan, 272f evaluation, 255 Murmur, 113 Muscle atrophy, signs, 22 Muscle fibers (hypertrophy), surgical pyloromyotomy procedure (usage), 155 Mycobacterium avium infection, 296 Mycobacterium tuberculosis infection, 32–33, 265 inhalation, 80 Mycoplasma pneumonia, causes, 78 Mycoplasma pneumoniae infection, 76 Myelin, 252 Myelocele, 261–263 Myelocytic leukemias, 302 Myelography, usage, 43–44 Myeloid tissue (bone marrow), 294 Myocardial infarction (MI), 124–126 coronary arteries, acute thrombus (impact), 125 Myocardial perfusion scan, 105–106, 125 Myocardium, 99 activity, increase (nuclear medicine perfusion scan), 106f contraction (systole), 100 relaxation (diastole), 100 N Napkin-ring carcinoma, 188 Nasal bone fracture, 399 lateral nasal bone radiograph, 399f Nasal cavities communication, 59 opacification, 90f Nasoenteric decompression tubes, usage, 149 Nasogastric (NG) tube, usage, 148–149 National Center for Health Statistics (NCHS) health/aging trends information, mortality rates reporting, National Child Abuse and Neglect Data System, 402 National Emergency X-radiography Utilization Study (NEXUS), 360–361 National health expenditures, 7t Neck fat deposits, excess, 347–348 Neck immobilization, 361 Neck vasculature carotid arteriogram, 261f MRA, 257f Necrotic lymph node, cardiophrenic angle (chest CT), 303f Needle guidewire localization, 311–312 Neisseria gonorrhoea infection, 34 Neoplasms origination, 14 small bowel neoplasms, 185 Neoplastic cells development, 14f histologic examination, 16–17 Neoplastic disease, 10, 13–17, 44–55 abdomen, 183–189 central nervous system, 275–287 computed tomography (CT), usage, 45 Neoplastic disease (Continued) female reproductive system, 316–319 gastrointestinal system, 183–189 hemopoietic system, 300–304 hepatobiliary system, 208–212 male reproductive system, 329–334 radiographic studies, 45 respiratory system, 89–94 urinary system, 241–245 Neoplastic lesions, radiographic appearance, 45 Nephroblastoma (Wilms tumor), 243–244 left kidney, computed tomography examination, 244f staging, 243–244, 244t Nephrocalcinosis, 355 Nephrogenic diabetes insipidus, occurrence, 347 Nephron, microscopic structure, 217f Nephron unit, composition, 216–217 Nephroptosis, 229 Nephrosclerosis, 238–239 Nerve cells, damage, 12 Neural arch, congenital defects (comparison), 261f Neural stimuli, 337 Neurofibromas, 285 Neurogenic bladder, 220–221 VUR result, 235–236 Neurogenic diseases, abdomen/ gastrointestinal system, 178–179 Neurons, 252 Newborn meningomyelocele, T1-weighted sagittal MRI view, 262f occipital bone, circular defect, 262f New Orleans helical computed tomography (HCT) rule, 360 Nidus, 48–49 Nonaccidental trauma (NAT), 400–402 Nonalcoholic fatty liver disease (NAFLD), 200 Noncomminuted fracture, 381–384 Noncommunicating hydrocephalus, 263 Nonglial neoplasms, 275–276 Nongranular leukocytes, 292 Nongravid women, screening, 310 Non-Hodgkin lymphoma (NHL), 303 chest CT, 303f nodal distribution, 304 pelvic CT scan, 304f signs/symptoms, 303 Nonobstructive jaundice (medical jaundice), 195, 208 Non-small cell lung cancer (NSCLC), 90–91 Nonstructural scoliosis, 29 Nonunion, 377 Norepinephrine, secretion, 338–339 Nuclear cardiology, 104–106 Nuclear medicine abdomen, 145–146 bone scans, helpfulness, 34–35 central nervous system, 259–260 INDEX Nuclear medicine (Continued) chest, 67–70 endocrine system, 341–342 gastric emptying scan, usage, 146f gastrointestinal system, 145–146 hepatobiliary system, 197 perfusion example, 69f scan, heart (appearance), 105f procedures, 24 testicular scan, torsion (presence), 331f Nuclear perfusion, usage, 130–131 Nucleus pulposus, 252–253 herniation, 268–270 O Obesity, impact, 121 Object-to-image receptor distance (OID), 101–102 Oblique fracture, 381–384 Oblique shoulder, radiograph, 36f Obstructive jaundice (surgical jaundice), 195, 208 Occipital bone circular defect, 262f depressed fracture, lateral skull radiograph, 367f Occult fractures, 390–391 Oligodendroglioma, 277–278 astrocytic tumor, 278 axial CT view, 279f Ollier disease (enchondromatosis), 46 Omentum, demonstration, 136f Oncogenes, 14 Open comminuted fracture forearm, anteroposterior projection, 375f tibia/fibula, amputation, 380f Open fracture, 377–379 Open reduction, 379–380 Open reduction internal fixation (ORIF), 379–380, 393 Operative cholangiography, 196 digital image, 196f Opportunistic fungal infections, 85 Opportunistic infection incidence (reduction), ART (impact), 297–298 Oral-antral fistula, sinusitis (relationship), 90f Orbits, lateral wall fractures (3-D CT reconstructions), 398f Osteitis deformans (Paget disease), 344–346 Osteoarthritis, 13, 37–39 classification, 37–38 degenerative joint disease, 37–38 demonstration, anteroposterior/oblique ankle radiographs, 38f pain/progressive stiffening, 39 Osteoblastic stage (Paget disease), 344–346 Osteoblastoma, 48–49 recurrence rate, 48 Osteoblasts, 21 invasion, 376f location, 22 449 Osteocalcin, bone tissue markers, 45 Osteochondrodysplasia, 25–26 Osteochondroma (exostosis), 45–46 cortex, blending, 45–46 knee joint, bilateral anteroposterior knee radiographs, 46f Osteoclastoma (giant cell tumor), 49–50 treatment, 50 types, 49–50 Osteoclasts, 21 Osteogenesis imperfecta (OI) (brittle bone disease), 24–25 congenita, 24–25 impact, tibia-fibular radiograph, 26f tarda, 24–25 Osteogenic sarcoma (osteosarcoma), 50–52 Osteoid osteoma, 48–49 axial CT scan, 49f hips, anteroposterior radiograph, 49f occurrence, 48–49 right femoral neck, coronal MRI, 49f Osteolytic stage (Paget disease), 344–346 Osteoma, 46 Osteomalacia, 343–344 cause, 343 Osteomyelitis, 31–32 result, 32 Osteonectin, bone tissue markers, 45 Osteopenia, 342 anteroposterior/lateral lumbar spine radiographs, 344f demonstration, 343–344 Osteopetrosis, 26–28 radiographic manifestations, 27–28 Osteophytes, 38–39 formation (demonstration), shoulder radiograph (usage), 39f Osteoporosis, 13, 342 classification, 342 evaluation, DXA (usage), 341 metabolic bone disorder, 342 risk factors, 343b Osteosarcoma (osteogenic sarcoma), 44, 50–52 aggressiveness, 50–51 diagnosis, 51 medullary extension, left femur (MRI), 51f periosteal reaction, 50–51 radiographic findings, 50–51 Osteoscleroses, 26–27 Out-of-pocket spending, CMS projections, 6–7 Outpatient hospital visits, number, 6f Ovarian cystic masses, 316–317 Ovarian mass CT scan, 318f sagittal/transverse sonographic image, 318f Ovaries, 13 follicular cyst, transvaginal sonographic image, 316f polycystic ovaries, 317 primary reproductive glands, 309 450 INDEX Overriding aorta, 118 Ovulation process, 309 Oxytocin, secretion, 337–338 P Pacemaker placement, portable chest radiograph, 73f Paget disease (osteitis deformans), 344–346 advanced proliferative phase, lateral skull radiograph, 345f cotton wool appearance, 344–346 stages, 344–346 tibia, advanced proliferative phase (radiograph), 346f Palmar inclination, loss (MRI scan), 378f Pancreas, 194, 337 carcinoma, 212 disorders, 348–351 head, pancreatic carcinoma, 212f illustration, 193f, 340f transverse sonographic image, 207f Pancreatic body, atrophy, 212f Pancreatic calcification, masses, 239f Pancreatic cancer, risk factors, 212 Pancreatic disorders, 348–351 Pancreatic duct (termination), endoscopic retrograde cholangiopancreatogram (usage), 195f Pancreatic head, carcinomas (visibility), 212 Pancreatic islets, 13, 340–341 Pancreatitis, 206–208 management, 207–208 pseudocyst, demonstration (computed tomography), 207f symptoms, 207 Papillary thyroid gland, 351–353 Paraesophageal hiatal hernia, 173 fundus, narrowing, 174f Paralytic ileus, 173–174, 177–178 postoperative patient, abdominal radiograph, 178f signs/symptoms, 177–178 Paranasal sinuses axial/coronal CT scans, 90f lining, 59 Parathyroid gland, 13, 337 disorders, 351–355 illustration, 339f Parathyroid hormone (PTH), antagonist (impact), 339–340 Paravertebral abscess formation, 32–33 Parenchymal cell proliferation/ differentiation, alteration, 13–14 Parenchymal changes, 83f Parenchymal infiltration, chest radiograph, 299f Parietal bone, linear skull fracture (lateral skull radiograph), 367f Parietal peritoneum, 308–309 Pars interarticularis, 42–43 Passive pneumoperitoneum, abdominal radiograph, 410f Patency, restoration, 110f Patent ductus arteriosus, 113–114 aortogram (usage), 115f flow diagram, 114f magnetic resonance imaging, usage, 115f Pathogenesis, Pathologic fracture, 381–384 humerus, radiograph, 385f Pathology disease, study, terms, 2–3 Pauciarticular JRA, 37 Peau d’orange appearance, 322–323 Pectus excavatum, 102–103 demonstration, lateral projection, 64f Pedunculated polyp, 186f Pelvic inflammatory disease (PID), 315 ectopic pregnancies, relationship, 326 treatment, 315 Pelvis anteroposterior, radiograph, 36f appendicitis, computed tomography, 167f frog leg lateral projection, left hip (congenital dislocation), 29f intertrochanteric fracture, anteroposterior projection, 381f left hip, trauma (radiograph), 380f skeletal metastatic disease, 331f Pelvis, carcinoid disease (bone scan), 25f Penetrating abdominal wounds, 409 Penetrating fractures, 387 Peptic ulcer, 160–161 mucous membrane, erosion, 160 Percutaneous cryoablation, 226 Percutaneous liver biopsy, 205 Percutaneous lung biopsy, 92 Percutaneous nephrostography, 224 Percutaneous radiofrequency ablation, 226 Percutaneous renal biopsy/drainage, 226 Percutaneous renal drainage tube, placement (fluoroscopic guidance), 224f Percutaneous transhepatic cholangiography (PTC), 195 usage, 195f Percutaneous transluminal angioplasty (PTA), 110–112 usage, 260–261 Percutaneous transluminal coronary angioplasty (PTCA), 110–112 Perfusion-weighted imaging (PWI), 256–258 Perihilar nodules, chest radiograph, 85f Perilunate dislocation, wrist (radiograph), 386f Periosteal reaction, 50–51 Periosteum, 22 Peripheral arterial disease (PAD), 123–124 Peripheral joints, rheumatoid joints (impact), 35–37 Peripheral vascular disease, risk (increase), 350–351 Peristalsis (reduction), glucagon (usage), 140 Peritoneal cavity, free air (presence), 139 Peritoneal sigmoid colon, 137–138 Peritoneum, 135–136 demonstration, 136f Periventricular hemorrhage (absence), sonogram, 259f Permanent catheterization, 110–112 Persistent cough, 82 Perthes, term (usage), 403 Pessary, insertion, 309 abdominal radiograph, 309f Phagocytes, location, 84 Phlebitis, 127 Physical maps, usage, Pigtail catheter, usage, 89f Pineal gland, 337 astrocytoma, T1-weighted sagittal MRI view, 279f calcification, lateral skull radiograph, 254f control, 338 illustration, 338f Pituitary adenoma, 281–282 right cavernous sinus, MRI T2-weighted coronal scan, 283f Pituitary fossa, visualization, 253–254 Pituitary gland, 13, 337 disorders, 346–347 illustration, 338f lobes, 337–338 suprasellar macroadenoma, T1-weighted coronal MRI view, 283f Pituitary macroadenoma, lateral skull radiograph, 254f Pituitary transcription factor gene (PROP-1), embryonic mutation, 347 Pituitary tumor, presence, 253–254 Placenta anomalies, 325 disorders, 326–327 sagittal sonographic view, 327f Placental percreta, 327 Placenta previa, 326–327 sagittal sonographic view, 327f Plaque formation, causes, 125 Plasma cells, M protein production, 300–301 Platelets (thrombocytes), 292–293 factors, release, 293f Platelike atelectasis, 406 left lung, posteroanterior projection, 407f Pleural effusion, 87–89 demonstration, sonograms, 88f pigtail catheter, placement, 89f presence, CT scan, 405f Pleural space, pigtail catheter placement (chest computed tomography scan), 89f Pleurisy, 87 chest radiography, 87 conventional chest radiography, 87 Pneumatic balloon dilators, usage, 159 Pneumococcal pneumonia commonness, 76–77 infiltrates, posteroanterior/lateral chest radiographs, 77f Pneumoconioses, 84–85 silicosis, 84 types, 84 Pneumocystis carinii infection, 296 Pneumocystis carinii pneumonia, 298 chest radiograph, 299f Pneumomediastinum (mediastinal emphysema) occurrence, 65 portable pediatric anteroposterior chest radiograph, 66f Pneumonia, inflammatory disease type, 11 Pneumoperitoneum, 409 causes, 410 football sign, 410 Pneumothorax, 102–103, 404–406 causes, 404–405 emphysematous blebs, impact (CT image), 405f lordotic chest radiograph, 63f radiographic appearance, 405 treatment, 406 Polyarticular JRA, 37 Polycystic kidney disease (PKD), 231–232 classification, 231–232 cysts, diagnosis, 232 visibility, CT scan, 232f Polycystic ovaries, 317 Polydactyly, 28 familial polydactyly, foot radiograph, 28f Polyhydramnios, 325–326 Polyps, pedunculation, 186f Polyuria (urination frequency), 347 Porcelain gallbladder, 211f Porous bones, development, 343 Port-a-Cath, access catheters, 71–72 Portal hypertension, varices (relationship), 201f Positive anterior fat pad sign (lateral elbow), 396f Positive pressure ventilator (PPV), usage, 74 Positron emission tomography (PET), 105–106 scanning, 24 usage, 69–70 Positron pathologies, positron emission tomography (PET), 24 Posterior cul-de-sac, bacterial fluid (transverse sonographic image), 315f Posterior lateral femoral condyle, nonunion (MRI scan), 378f Posterior lobe, 337–338 Posterior mediastinal masses, origin, 64 Posterior thorax, congenital intrathoracic rib, 64f Posterior tibialis muscle, strain injury (axial/ sagittal MRI), 40f Postmenopausal primary osteoporosis, 342 Postradiation sarcoma, 50 Postreduction lateral wrist image, wrist cast alignment, 374f Postvoid image, 219–220 Pott disease, 32–33 INDEX Pott fracture, 392–393 ankle, anteroposterior/lateral projections, 393f–394f Preeclampsia, 325 Pregnancy disorders, 325–328 ectopic pregnancy, 326 placenta, disorders, 326–327 Sheehan syndrome, 347 Pregnant uterus (assessment), sonography (usage), 312 Premature infants distal esophagus distension, lateral view, 152f hyaline membrane disease, 75 trachea, discontinuity, 152f Premature neonate head, sonogram, 259f Preterm infant, respiratory distress syndrome, 76f Prevalence, Primary brain tumors characteristics, 275 classification, 275–276 Primary breast cancer, metastatic disease (anteroposterior hip radiograph), 54f Primary bronchogenic neoplasm, metastatic spread (axial MRI), 93f Primary diagnostic/staging methods, 16 Primary hyperparathyroidism, 353 impact, 353–355 Primary osteoarthritis, 37–38 Primary osteoporosis (type 1), 342 PR interval, 100 Private insurance, increase (CMS projection), 6–7 Profuse hematuria, 241 Prognosis, Progressive disseminated histoplasmosis, 85–86 Prolactin-secreting adenomas, 281 Prolactin (PRL), secretion, 337–338 Proliferation, 13–14 Properitoneal fat stripes, visibility, 138 Prostate gland cancer, staging, 331 carcinoma, 330–331 enlargement, axial T2-weighted MRI scan, 330f coronal T2-weighted MRI scan, 329f transurethral resection of the prostate (TURP), 330 Prostate-specific antigen (PSA) test, 328–329 Prostatic calculi, 330 Prostatic hyperplasia, 329–330 Prostatic urethra, mucosal margin, 221f Prosthetic shoulder replacement, placement (radiograph), 36f Prosthetic valve replacements, lateral chest radiograph, 120f Protease, impact, 296 Protein, genetic abnormality (impact), 2–3 Provisional callus, 375–377 451 Proximal colon incidence, 187 ulcerative colon, left posterior oblique barium enema radiograph, 168f Proximal GI lesions, suspicion, 187–188 Proximal interphalangeal joint, subluxation (anteroposterior view), 400f Proximal right pulmonary artery, SwanGanz catheter placement, 72f Pseudocyst, 206–207 demonstration, computed tomography, 207f Pseudofractures (Looser zones), 343–344 Pseudopneumothorax, 405 Pseudopolyps, 167–168 presence, 168f Psoas major muscle shadows, intravenous urogram, 218f Psoas muscles, demonstration, 139f Psoriatic arthritis, 34 Pulmonary angiography, usage, 130–131 Pulmonary artery catheter (Swan-Ganz catheter), 71 hypertension, 121 Pulmonary emboli (PE) cardiovascular system, 128–131 occurrence, 128–130 thromboembolism, 128–130 Pulmonary embolism computed tomography angiogram, 130f evaluation, nuclear medicine perfusion/ ventilation scan (usage), 69f Pulmonary emphysema, 102–103 giant emphysematous bleb, radiograph, 83f Pulmonary fibrosis, pneumoconioses (impact), 84 Pulmonary hemodynamics, change, 128–130 Pulmonary metastases, 93 lateral projection, uterine cancer (impact), 94f uterine cancer, 94f Pulmonary stenosis, 118 Pulmonary tuberculosis, 80–82 cause, 80 contagiousness, 82 Pulmonary vascular congestion, increase, 114 Pulmonary vessels, filling (aortogram), 115f Pulsion diverticulum, 179 P wave, 100 electrocardiogram, 100f Pyelonephritis, 233–235 treatment, 234–235 Pyloric muscle hypertrophy, olive sign, 153 tone, spasmodic changes, 153 Pylorus, barium (flow), 154f Pyramidal fracture (LeFort II), 396–398 Q QRS complex, 100 QRS wave, electrocardiogram, 100f 452 INDEX Quantitative computed tomography (QCT), 23–24 R Radioactive iodine uptake, increase (nuclear medicine 123iodine thyroid uptake scan), 353f Radiography abdomen, 138–142 cardiovascular system, 101–103 central nervous system, 253–254 endocrine system, 341 esophagus, 140 gastrointestinal system, 138–142 hepatobiliary system, 194–195 large bowel, 141–142 respiratory system, 59–70 small bowel, 141 stomach, 140–141 traumatic disease, 360 usage, 22–23 Radiolucency midshaft, AP humerus radiograph, 47f Radiolucent ulcer crater, evidence, 161f Radiolucent uric acid stone, 237f Radionuclide ventriculograms, 106 Radius, fracture posteroanterior projection, 376f radiograph, 382f Rearranged during transfection (RET) proto-oncogene, 156 Recessive inherited disease, 11 Recombinant parathyroid hormone (rPTH), usage, 339–340 Rectal carcinomas (staging), TRUS (usage), 189 Rectosigmoid, barium enema, 157f Rectosigmoid colon, apple core lesion, 188f Rectum, 137–138 Red blood cells (erythrocytes), 291 trapping, 293f Red bone marrow, presence, 20–21, 53–54 Reflux scintigraphy, Tc-99m-labeled sulfur colloid (usage), 159–160 Regional enteritis (Crohn disease), 163–166 bimodal distribution, 163 distribution patterns, 169f Regional lymph node metastasis, indication, 16 Regional osteoporosis, 342 Regurgitation, 119f mitral regurgitation, hemodynamic effect, 119f severity, color Doppler echocardiography (usage), 120 Reiter syndrome, 34 nonsteroidal antiinflammatory drugs (NSAIDs), usage, 34–35 Relative cerebral blood volume (rCBV), 256–258 Renal agenesis, 227–228 Renal angiography, 223 Renal arteries, contrast-enhanced threedimensional MRA image, 224f Renal calculi, 223 location/treatment, 224 Renal cell carcinoma (RCC), 241–243 staging, 243t T1-weighted axial MRI view, 287f Renal colic, 238 Renal cysts, 241 Renal failure, 230, 239 Renal function, deterioration, 239 Renal hypoplasia, vasculature, 228f Renal muscle shadows, intravenous urogram, 218f Renal pelvis anomalies, 229 cystogram, 231f dilatation, 240–241 Renal stone, sonogram, 222f Reproductive system anatomy/physiology, 308–310, 328 breast carcinoma, 321–325 breast masses, 320–325 computed tomography, 314 congenital anomalies, 314–315, 329 cystadenocarcinoma, 318–319 ectopic pregnancy, 326 female reproductive system, 308–328 fibrocystic breasts, 321 hydatidiform mole, 327–328 hysterosalpingography, 310–311 imaging considerations, 310–314, 328–329 inflammatory diseases, 315–316 magnetic resonance imaging, 312–314 male reproductive system, 328–334 mammography, 311–312 neoplastic diseases, 329–334 pathology, summary, 334b placenta, disorders, 326–327 pregnancy, disorders, 325–328 prostate, carcinoma, 330–331 sonography, 312 uterine masses, 319–320 Respiratory distress syndrome (RDS), 76f hyaline membrane disease, 75 signs, 75–76 Respiratory epithelium, 59 Respiratory failure, 73–74 occurrence, 73–74 Respiratory system additive pathologies, 60 anatomy/physiology, 59 anteroposterior (AP) projections, 62 automatic exposure control (AEC), usage, 60 chest radiography, 61–63 components, 60f direct readout image receptors, usage, 59–60 erect posteroanterior chest/erect lateral chest, 61f exposure factor conditions, 59–60 Respiratory system (Continued) imaging considerations, 59–70 pathology, summary, 94b–95b photostimulable phosphor-computed tomography imaging plates, usage, 59–60 position, 61 arrangement, 61 posteroanterior (PA) projections, 62 projection, 61 x-ray beam, impact, 61 radiography, 59 recumbent anteroposterior chest, lower lung fields (obscuration), 61f subtractive pathologies, 60 Reticuloendothelial system, 291 Retrograde cystography, 220–221 Retrograde pyelography, 221–222 Retrograde, term (usage), 221–222 Retrospondylolisthesis, 41 Retroverted fundus, 314–315 Reverse transcriptase, 296 Rheumatoid arthritis (RA), 34–37 first metacarpophalangeal joint, subluxation, 36f genetic factors, 35 juvenile rheumatoid arthritis (JRA), 37 peripheral joint involvement, 35–37 presence, criteria, 35–37 Rheumatoid fever, 119 Rh factor, 292 Rh-negative factor, 292 Rh-positive factor, 292 Ribonucleic acid (RNA) genome, 11 viral RNA, conversion, 296 Ribs bilateral lumbar ribs, anteroposterior lumbar spine radiograph, 30f fractures hemorrhage, pediatric chest radiograph, 403f fractures, visibility, 63 metastatic disease, bone scan, 25f notching, 114–116 Rickets, 343 Right acoustic neuroma, T2-weighted axial MRI view, 285f Right atrium, 98 deoxygenated blood, return, 117 Right breast, stellate mass (mammogram), 324f Right cavernous sinus, pituitary adenoma (MRI T2-weighted coronal scan), 283f Right femoral head, posterior dislocation (pelvic radiograph), 402f Right femoral neck, osteoid osteoma (coronal MRI), 49f Right hand (fifth metacarpal head), boxer’s fracture (radiograph), 391f Right heart border, enlargement (chest radiograph), 117f Right hemithorax (metastatic disease), hypermetabolic activity (PET demonstration), 146f Right hepatic vein, shunt (installation), 111f Right hilar mass, bronchogenic carcinoma (posteroanterior projection), 92f Right humerus (proximal diaphysis), calcification (shoulder radiograph), 47f Right hypochondriac region, 135 Right iliac region, 135 Right interjugular vein, Swan-Ganz catheter placement, 72f Right kidney atrophic right kidney, abdominal CT image, 228f cyst, abdominal CT scan, 241f fracture, intravenous urogram, 409f hydronephrosis, 240f renal stone, scout film, 225f scarring, intravenous urogram, 234f Right knee rotary injury, MRI scan, 390f tumor demonstration, anteroposterior radiograph, 51f Right lower lobe atelectasis, posteroanterior erect chest radiograph, 87f Right-lower quadrant (RLQ), 135 Right lumbar region, 135 Right lung anteromedial aspect, bronchogenic mass (CT scan), 92f cavitation, tubercular lesion (expansion), 81f chest tube placement, radiograph, 71f mass, CT-assisted core biopsy, 68f pneumatoceles, presence, 77f pneumococcal pneumonia infiltrates, posteroanterior/lateral chest radiographs, 77f tension pneumothorax, 406f upper lobe, bronchogenic lesion (chest CT scan), 92f Right maxillary sinus, comminuted fracture, 3-D CT reconstruction, 398f Right ovary cyst (coronal T2-weighted fat-suppressed MRI scan), 316f Right percutaneous nephrostomy placement, abdominal CT scan, 227f Right percutaneous renal drainage tube, placement (fluoroscopic guidance), 224f Right popliteal artery (embolus), urokinase (spray), 110f Right pulmonary artery, pulmonary embolism (CT angiogram), 130f Right renal pelvis, noncalcified filling defect, 237f Right renal stone, abdominal CT stone study, 237f Right-sided failure (CHF), 121 Right-sided heart hypertrophy, 82 Right-sided rib fractures, right clavicular fracture (combination), 64f INDEX Right testicle blood flow, absence, 331f echogenic heterogeneous mass, testicular sonogram, 333f Right upper lobe, traumatic pneumothorax/ atelectasis (anteroposterior chest image), 405f Right-upper quadrant (RUQ), 135, 193 pain, 209 Right ureter, stent placement, 225f Right ventricle, 98 contraction, comparison, 114 enlargement, 118 hypertrophy, 118 Right wrist, occult, oblique, intraarticular distal radial fracture (radiograph), 390f Right zygomatic bone, tripod fracture (CT image), 397f Ring lesion, T1-weighted coronal MRI view, 266f Rolling hiatal hernia, 173 Rotator cuff disease, calcific tendonitis (radiograph), 41f Rothmund-Thomson syndrome, 50 Rupture (hernia), 170 S Saccular abdominal aneurysm, abdominal aortogram, 127f Saccular aneurysms, 126 Sacral nerves, 137–138 Sacroiliac joints impact, 34 obliteration, 37 Sagittal suture, premature closure (lateral skull radiograph), 31f Sagittal/transverse sinuses, two-dimensional flight MRI, 124f Salmonella contamination, 162 Salter-Harris system, 387–388 Sarcoma, 16 genetic instability, impact, 50 postradiation sarcoma, 50 Scapula acromion process, dislocation (weightbearing acromioclavicular radiograph), 402f coracoid process, location, 401f subcutaneous cyst, MRI scan, 23f Schatzki ring, 173f Schwannoma, 284–285 T1-weighted sagittal MRI view, 286f Sclerotic disease processes, Scoliosis, 29 correction, 29–30 diagnosis/treatment, radiography (importance), 29–30 nonstructural scoliosis, 29 Scotty dog anatomic components, 43t collar/broken neck, 42–43 neck, break, 44f 453 Secondary hyperparathyroidism, 353 response, 355 Secondary hyperparathyroidism, hand (radiograph), 355f Secondary osteoarthritis, 37–38 Secondary osteoporosis (type 2), 342 cause, 342 Second lumbar vertebral bodies, compression fractures (lateral lumbar radiograph), 364f Second/third metacarpals, transverse fractures (radiograph), 384f Seeding, 14–16 Segmental pneumonia, 76 Seizures, MRI (sagittal T1-weighted view), 256f Sella turcica, 337–338 enlargement, 341, 346 lateral skull radiograph, 254f Seminal vesicles, 328 Seminoma, testicular sonogram, 333f Senile primary osteoporosis, 342 Sentinel node, 14–16 Septal defects, 116–117 Sequelae, Sequestrum, 32 axial MRI image, 33f Serologic rheumatoid factor (serologic RF), 35 Serum creatinine, 217–218 Severe pneumonia, 73–74 Shaken baby syndrome, 403 Shearing injury, corpus callosum (T2-weighted MRI scan), 368f Sheehan syndrome, 347 Shock wave lithotripsy (SWL), 224 Short-tau inversion recovery (STIR), 268–270 Shoulders humeral head, anterior dislocation (anterorposterior/oblique/ transscapular projections), 401f humeral neck fracture, motor vehicle accident (anteroposterior projection), 376f humerus, posterior dislocation (radiograph), 402f joints, dislocation, 399–400 left shoulder, calcific tendonitis (radiograph), 41f radiograph, osteophyte (formation demonstration), 39f right humerus, proximal diaphysis (radiograph), 47f Sickle cell disease, 298–300 Sigmoid colon, 137–138 mass, endoscopic image, 148f wall, pedunculated polyp, 186f Sign, Silicosis, 84 Simple cuboid epithelial cells, adaptive alterations, 10f 454 INDEX Simple fracture (closed fracture), 377–379 Simple unicameral bone cyst (simple UBC), 46–48 Single-nucleotide polymorphisms (SNP), Single photon emission computed tomography (SPECT), 105–106 examinations, 197 Sinoatrial (SA) node, location, 100 Sinusitis, 89 left maxillary sinus, air-fluid level (presence), 90f radiography, importance, 89 treatment, 89 Skeletal defects, presence, 301f Skeletal disorders, endocrine system, 342–346 Skeletal fractures, treatments, 379–380 Skeletal modeling, 26–27 Skeletal radiograph, examination, 22 Skeletal system achondroplasia, 25–26 anatomy/physiology, 20–22 bones, 21–22 computed tomography (CT), 23–24 congenital/hereditary diseases, 24–31 cranial anomalies, 30–31 hand/foot malformations, 28 hip, developmental dysplasia, 28–29 imaging considerations, 22–24 magnetic resonance imaging, 23 nuclear medicine procedures, 24 pathology, summary, 55b radiography, 22–23 performing, 375 vertebral anomalies, 29–30 vertebral column, 41–44 Skeletal trauma, 373–404 evaluation, radiography (importance), 373–374 soft tissue injuries, 375 Skeleton appendicular skeleton, 21f axial skeleton, 21f Skin, Kaposi sarcoma (chest radiograph), 299f Skull acromegaly, radiograph, 347f fractures, visualization, 366 injuries, 365–371 inner/outer tables, changes, 345f lateral projection, 265f thickening, 281 Sliding hiatal hernia esophagus, narrowing, 172f Schatzki ring, 173f Slipped capital femoral epiphysis (SCFE), 388–389 Small bowel, 137 bowel, malrotation, 155f divisions, 137f examination, 158f gas, indication, 139 Small bowel (Continued) loops anterior abdominal hernia, CT image, 171f presence, 162f magnetic resonance enterography (MRE), 144–145 neoplasms, 185 prone cross-table lateral view, 171f radiograph, 141f radiography, 141 skip areas, 164f study, gluten-sensitive enteropathy, 158f Small-bowel follow-through (SBFT) screening tool, 164–165 Small bowel obstruction (SBO), 173t, 176–177 Small cell lung carcinoma (SCLC), posteroanterior chest radiograph, 91f Small intestines loop, 230f radiographic study, 141 Small vessel disease, 274 Smith fracture, 391 Soft plaque (demonstration), multislice computed tomography (usage), 123f Soft tissue chest, 63 cortical (compact) bone, interface, 22–23 diagnosis, 22 injuries, skeletal trauma (impact), 375–377 swelling, demonstration, 34 Somatic cells, chromosomes (existence), 10–11 Sonography abdomen, 145 central nervous system, 259 diagnostic capabilities, enhancement, 196–197 female reproductive system, 312 gastrointestinal system, 145 reproductive system, 312 urinary system, 222 Sonohysterography (SHG), 310–311 Source-to-image receptor distance (SID), 101–102 Spermatocele, 332 testicular sonographic scan, 333f Sphenoid sinus, air fluid levels (CT scan), 367f Sphincter of Oddi, 194 Spina bifida (meningomyelocele), 30, 261–263 Spina bifida occulta, 261f abdominal radiograph, 30f Spinal column injuries, radiographic indications, 41 Spinal cord compression, T1-weighted sagittal MRI view, 271f depiction, MRI (usage), 270 Spinal injury, result, 365 Spinal laminar line, disruption, 364f Spinal tumors, 285–287 distribution, 287f Spine cervical spine, anterospondylolisthesis (lateral spine radiograph), 43f degenerative disk disease, T1-weighted sagittal MRI view, 269f evaluation, radiography (role), 254 hyperextension injuries, 42f hyperflexion injury, 42f injury, result, 365 lumbar spine, spondylolisthesis (sagittal reconstruction), 43f meningioma, presence (T1-weighted sagittal MRI view), 287f skeletal metastatic disease, 331f stable injuries, impact, 365 tuberculosis, 32–33 Spiral fracture, 381–384 humerus, radiograph, 384f Spleen (rupture), blunt trauma (axial CT images), 408f Splintered fracture, 381 Spondylolisthesis, 41 surgical fusion, L5-S1 lateral radiograph, 43f Spondylosis, 42 traumatic spondylosis, 362–363 Squamous cell carcinoma, 244–245 Staghorn calculus, 236–238 abdominal radiograph, 237f Staphylococcal pneumonia occurrence, 77 pneumatoceles, presence, 72f Staphylococcus aureus infection, 31–32, 76 Staphylococcus saprophyticus infection, 235 Steatosis, 200 Stein-Leventhal syndrome, 317 Stenosed valve, open valve, 119f Stenosis anorectal stenosis, 154f hypertrophic pyloric stenosis (HPS), 152–155 left anterior oblique projection, coronary arteriogram, 126f percentage, impact, 103–104 Stenotic terminal ileum, string sign, 163f Stents arterial stents, usage, 110–112 placement, 110–112, 225f usage, 112f Stomach adenocarcinoma, 185f barium, flow, 154f cardia, filling defects, 169f distension, double bubble sign, 153f emptiness, depiction, 137f emptying delay, nuclear medicine gastric emptying scan (usage), 146f malrotation, 175f patient positions, 140–141 Stomach (Continued) perforation, passive pneumoperitoneum (abdominal radiograph), 410f radiograph, 140f radiography, 140–141 tumors, 184–185 Zenker diverticulum, 180f Strangulated hernia, 170 Streptococcus pneumonia infection, 76 Stress echocardiography, 103 Stress fractures, 389–390 distal tibia, ankle radiograph, 389f occurrence, 389–390 Stress radiography, usage, 375 Stretch fractures, 389–390 String sign, 163f Stroke (cerebrovascular accident), 272 diagnosis, noncontrast brain CT (usage), 267 risk, increase, 350–351 Subarachnoid brain hemorrhage, 275 axial MRI images, 373f sagittal FLAIR image, 373f Subarachnoid hematoma, 371 Subarachnoid space, CT myelogram, 44f Subcutaneous emphysema, 66 presence, radiograph, 67f Subdural empyema, 268 Subdural hematoma, 369–371, 370f bilateral subdural hematoma, T1-weighted MRI view, 372f brain tissue, left frontoparietal area (CT demonstration), 371f T1-weighted sagittal MRI view, 372f Subluxation, 399 Submucosa, inflammation, 167 Subserosal fibroid, axial T2-weighted fat-suppressed MRI image, 313f Subtractive disease process, Subtractive pathologies, 60 Superficial rectal carcinomas (staging), TRUS (usage), 189 Superinfections, 79 Superior mesenteric artery (SMA), position (demonstration), 156 Superior vena cava (SVC), catheter placement, 71–72 Supernumerary kidney, 228 Supine abdominal radiographs, usage, 409 Supracondylar fracture, elbow (anteroposterior/lateral projections), 381f Surgical enterostomy procedure, contrast agent (administration), 142 Surgical jaundice (obstructive jaundice), 195, 208 Swan-Ganz catheter (pulmonary artery catheter), 71 placement, 72f Sylvian triangle, 281–282 Symptom, Symptomatic reflux (heartburn), 159 Synarthroidial joints (fibrous joints), 22 INDEX Syndactyly, 28 Syndrome, Synovial joints (diarthrodial joints), 22 Systemic circulation, flow diagram, 101f Systemic JRA, 37 Systole, myocardium (contraction), 100 T Talipes (clubfoot), 28 Tarsal bone erosion (demonstration), posteroanterior/lateral foot radiographs (usage), 40f Tc-99m pertechnetate, injection, 156–157 Tc-99m white blood cell (WBC) imaging, 165 Temporal bone (petrous portion), posterior fossa (CT scan), 257f Temporal lobe infarct, T1-weighted sagittal MRI view, 372f Temporoparietal regions, fractures (3-D CT reconstructions), 398f Tendonitis, 39–41 medical treatment, 41 Tendons, attachment, 39–41 Tenosynovitis, 39–41 Tension pneumothorax occurrence, 405–406 right lung, 406f Tenth Revision, International Classification of Diseases (ICD-10), mortality codes (collection), Tentorium cerebelli, 250–251 Terminal ileum, 137–138 barium (presence), radiograph (usage), 141f entry, 155f Testes, 13 Testicles hydrocele, visualization, 332f malignant testicular tumors, 332 superior aspect, hypoechoic mass, 333f Testicular choriocarcinomas, 333 Testicular embryonal carcinomas, 333 Testicular masses, 331–334 Testicular seminomas, 333 Testicular teratomas, 333 Testicular torsion, occurrence, 331–332 Tetralogy of Fallot, 118 flow diagram, 118f infant, chest radiograph, 118f Thalassemias, 300 classification, 300 Therapeutic angiography, 110–112 Third lumbar vertebra, burst fracture (CT scan), 24f Thoracentesis, performing, 88f Thoracic aorta, dilatation (posteroanterior chest radiograph), 124f Thoracic aortic aneurysm posteroanterior chest radiograph, 129f result, 126–127 Thoracic cavity, enclosure, 63 455 Thoracic vertebrae metastatic disease, bone scan, 25f spaces, visibility, 62 Thoracotomy, usage, 85f Thorax anatomic bony structures, 59 oblique projections, 62–63 pneumothorax, 102–103, 404–406 posterior thorax, congenital intrathoracic rib, 64f trauma, 404–406 Thrombin, formation, 293f Thrombocytes (platelets), 291–293 Thromboembolism (pulmonary embolus), occurrence, 128–130 Thrombolysis, 110–112 procedure, 110f Thrombolytic therapy, usage, 131 Thrombophlebitis, 127 Thrombus, 273–274 origin, 128–130 Thymus enlargement, sail sign, 65f gland, 337 sail sign, PA/lateral views, 64–65 Thyroid cancers, 351–353 Thyroid gland, 13, 337 disorders, 351–355 function (evaluation), iodine-123 uptake (usage), 341–342 glandular enlargements, 66 illustration, 339f malignant thyroid glands, types, 351–353 Thyroid hormone (TH), secretion, 339–340 Thyroid-stimulating hormone (TSH) secretion, 337–338 suppression, 351 Thyroid storm, 351 Thyroxine (T4), 339–340 Tibia advanced proliferative Paget disease, radiograph, 346f comminuted fracture, computed radiography, 374f distal tibia, stress fracture (ankle radiograph), 389f epiphyseal-metaphyseal fracture, lower leg radiograph, 388f fracture, open reduction internal fixation (radiograph), 382f open comminuted fracture, amputation, 380f Tibia-fibula radiograph, usage, 26f Tissue connective tissue, 20 remodeling, 12 repair, 12 soft tissue, diagnosis, 22 Tophi, 39 Torus fracture, 386–387 distal radius, radiograph, 387f Towne method projection, mandibular fracture, 398f 456 INDEX Toxic diseases, causes, 11 Toxic gas/smoke inhalation, 73–74 Toxic megacolon, barium enema demonstration, 168f Toxoplasma gondii infection, 296 Trabeculae, 20–21 Trabecular pattern, 20–21 Trabeculated bladder, 236f cystogram, 231f Trachea carina, bifurcation, 60f compression, 351–353 discontinuity, 152f displacement, 66 mediastinal hematoma, impact (CT scan), 405f narrowness, 66 Tracheobronchial tree, mucous lining (filtration), 84 Tracheoesophageal fistulae, 152f atresia, relationship, 151 types, 151f Traction diverticulum, esophagus (outpouching), 180f Tractography, 255–256 Transabdominal pelvic sonography, 312 Transesophageal echocardiography (TEE), 103 Transforming growth factor-alpha (TGF-α), impact, 152–153 Transient ischemic attacks (TIAs), 273–274 duplex Doppler sonography, usage, 259 Transitional cell carcinoma, 244–245 Transitional vertebra, 30 Transjugular intrahepatic portosystemic shunt (TIPSS), 110–112 usage, 170 Transposition of great vessels, 117 angiogram, 118f anomaly, 117 flow diagram, 117f Transrectal ultrasonography (TRUS), 189 usage, 187–188 Transudates, 87 Transurethral resection of the prostate (TURP), 330 Transurethral resection, scarring, 221f Transverse colon, 137–138 filling defect, 186f Transverse diaphyseal fracture, distal fibula (lower leg radiograph), 388f Transverse fractures (LeFort III), 381–384, 396–398 femur, anteroposterior projection, 385f humerus, anteroposterior projection, 385f second/third metacarpals, hand radiograph, 384f Transverse sinuses, two-dimensional flight MRI, 124f Trauma advanced trauma life support (ATLS), provision, 360 Trauma (Continued) brain trauma, 367–369 centers, levels, 359–360 deaths, distribution, 359f Traumatic aortic injury, CT scan, 405f Traumatic brain injury (TBI), 367 Traumatic diaphragmatic hernia, chest radiograph, 409f Traumatic disease, 10, 13 abdominal trauma, 406–410 atelectasis, 73–74, 406 avascular necrosis, 403 battered child syndrome, 400–403 brain, injuries, 365–371 chest, trauma, 404–406 computed tomography, 360–361 dislocations, 399–400 head, trauma, 361–371 imaging considerations, 360–361 Legg-Calvé-Perthes disease, 403–404 pathology, summary, 410b radiography, 360 skeletal trauma, 373–404 skull, injuries, 365–371 thorax, trauma, 404–406 vertebral column, trauma, 361–371 Traumatic pneumothorax, right upper lobe (anteroposterior chest image), 405f Traumatic spondylosis, 362–363 Treatment modalities, 16 Triiodothyronine (T3), 339–340 Trimalleolar fracture, ankle radiograph, 395f Tripod fracture, 396 right zygomatic bone, CT image, 397f Trophoblastic tissue, 327–328 Troponin I/T (cardiac biomarker), 126 T-score, usage, 341 T-tube cholangiography, 196 Tubercular lesion, expansion, 81f Tuberculosis, 32–33 diagnosis, 80–81 immunocompromise, 81–82 miliary tuberculosis, 81 necrosis, 81 pulmonary tuberculosis, 80–82 spine, 32–33 Tuberculous scars, presence, 81 Tumor-node-metastasis (TNM) system basis, 16 emergence, 16 Tumor-suppressor genes, 14 T wave, 100 electrocardiogram, 100f Twisting injury, humerus (radiograph), 384f 2-D echocardiography, 103 usage, 116 Type diabetes mellitus (juvenile diabetes), 348 Type diabetes mellitus (insulin-resistant diabetes), 350 Type A blood, 291–292 Type B blood, 291–292 Type O blood, consideration, 292 U Ubiquitin-specific protease (USP6), 48 Ulcerative colitis, 167–168 colonoscopy, 167–168 distribution patterns, 169f proximal colon, left posterior oblique barium enema radiograph, 168f sigmoidoscopy, 167–168 signs/symptoms, 167 toxic megacolon, barium enema demonstration, 168f treatment, 168 Ulcer crater, prone right anterior oblique projection, 161f Ulcers, treatment, 161 Ulna cortex, incomplete break (radiograph), 387f fracture, radiograph, 382f middle portion, greenstick fracture (radiograph), 387f Umbilical region, 135 Undifferentiated anaplastic cancers, 351–353 Undifferentiated large cell carcinoma, 90–91 Undifferentiated small cell carcinoma, 90–91 Undifferentiated, term (usage), 13–14 Unfused sutures, overgrowth, 30–31 Unicameral bone cyst (UBC), 46 proximal humerus, radiolucencies (anteroposterior projection), 47f radiographic appearance, 46–48 Unicornuate uterus, 314 Upper abdomen, lymph nodes (CT), 294f Upper GI (UGI) radiologic procedure, 140 Upper GI (UGI) sensitivity/specificity, 159 Upper GI (UGI) series, 153 Upper GI (UGI) study, 155 Uremia, 239 Ureteral diverticula, 230–231 Ureteral stent abdominal CT scan, 227f surgical placement, 226 Ureterocele, 230 Ureters anomalies, 229 congenital double ureter, presence, 230f entrance, intravenous urography (right posterior oblique projection), 220f extension, 217 left ureteric diverticula, double densities (intravenous urogram), 231f left ureter, retrograde pyelogram, 229f peristaltic activity, 219–220 shortening, urogram, 230f tortuosity, cystogram, 231f Urethral diverticula, voiding cystourethrogram, 221f Urethral stricture, retrograde urethrography, 221f Urethral valves, mucosal folds, 230–231 Uric acid, crystallization, 39 Urinary bladder indentation, 330f pelvic CT examination, 245f Urinary catheterization, 226–227 Urinary disorders, 217–218 Urinary system, 135 acute glomerulonephritis, 235 anatomy/physiology, 216–217 bladder carcinoma, 244–245 calcifications, 236–238 computed tomography, 222–223 congenital diseases, 227–232 cystitis, 235–236 cystography, 220–221 degenerative diseases, 238–241 hereditary diseases, 227–232 hydronephrosis, 240–241 illustration, 216f imaging considerations, 217–218 inflammatory diseases, 232–236 interventional procedures/techniques, 224–226 intravenous urography (IVU), 218–220 kidney fusion anomalies, 228–229 position anomalies, 229 KUB radiography, 218–227 lower urinary tract anomalies, 230–231 magnetic resonance imaging, 223–224 medullary sponge kidney, 232 neoplastic diseases, 241–245 nephroblastoma (Wilms tumor), 243–244 nephrosclerosis, 238–239 pathology, summary, 246b polycystic kidney disease (PKD), 231–232 pyelonephritis, 233–235 renal angiography, 223 renal cell carcinoma (RCC), 241–243 renal cysts, 241 renal failure, 239 renal pelvis anomalies, 229 retrograde pyelography, 221–222 sonography, 222 ureter anomalies, 229 visualization, 218–219 Urinary tract calcifications, 238 Urinary tract infection (UTI), 226–227, 232–233 Urinary tubes/catheters, usage, 226–227 Urination frequency (polyuria), 347 Urine, drainage, 225f–226f U.S Department of Health and Human Services (USDHHS), mortality rates reporting, U.S health expenditures, growth rate (impact), 6–7 INDEX U.S population, uninsured number, 6–7 percentage, 8f Uterine cancer, cotton ball appearance, 94f Uterine fibroids (leiomyomas), 319–320 misnomer, 319–320 Uterine masses, 319–320 Uterine tubes, free spillage (hysterosalpingogram), 310f Uterus bicornuate uterus, 314 description, 308–309 didelphys, 314 fibroids, sagittal sonographic image, 320f fundus, fibroid location (sagittal sonographic image), 320f molar tissue, sagittal sonographic image, 328f pregnant uterus (assessment), sonography (usage), 312 sagittal sonographic image, 313f sagittal T2-weighted MRI scan, 313f unicornuate uterus, 314 V Vagina, pessary insertion (abdominal radiograph), 309f Valve leaflets (cusps), position, 119f Valves, damage, 119 Valves of Houston, 137–138 Valvular disease, cardiovascular system, 118–120 Valvular stenosis, 119f cause, 119 Varices, portal hypertension (relationship), 201f Vascular access lines, 70–73 Vascular disease central nervous system, 272–275 treatment, stenosis percentage (impact), 103–104 Vascularity, increase, 31–32 Veins, 100 inflammation (phlebitis), 127 Vena cava filter placement, abdominal radiograph, 130f Venous blood flow, sagittal/transverse sinuses (twodimensional flight MRI), 124f return, 251–252 Venous drainage, illustration, 252f Venous thrombosis, cardiovascular system, 127–128 Ventilation, 59 Ventilation lung scans (VQ scans), usage, 130–131 Ventilation scan, example, 69f Ventricles, interconnected cavities, 251 Ventricular pacing electrodes, placement, 73 457 Ventricular septal defect, 118 chest radiograph, 117f flow diagram, 116f involvement, 116–117 Ventricular septum, defect, 116 Ventricular system, lateral/superior views, 251f Ventriculojugular shunt placement, skull (lateral projection), 265f Vertebra (vertebrae) anomalies, 29–30 fractures/dislocations, impact, 365 subluxation, hyperflexion (impact), 42f transitional vertebra, 30 Vertebral arch, median segment, 261f Vertebral artery, contrast-enhanced three-dimensional magnetic resonance angiography, 110f Vertebral bodies comminuted fractures, axial CT scan, 365f second/fourth vertebral bodies, compression fractures (lateral lumbar radiograph), 364f Vertebral bodies, height (loss), 42 Vertebral column, 41–44 evaluation, diskography (usage), 270 injuries, 362–365 causes, 41, 362 osteoarthritic column, impact, 270 trauma, 361–371 Vesicoureteral reflux (VUR), identification, 220–221 Vessel occlusion, 273–274 Viral hepatitis, 203–205 characteristics, 204t diagnosis, 204 Viral pathogens, impact, 76 Viral pneumonia (interstitial pneumonia), 79 Virtual colonoscopy, 144 Virulence, 12–13 Visceral cranial fractures, 396–399 Vitamin D-resistant rickets, femur (radiograph), 345f Voiding (micturition) cystography, usage, 220–221 Volumetric CT, usage, 67 Volvulus, 175 cecal volvulus, barium enema radiograph, 176f illustration, 175f von Willebrand disease, 300 von Willebrand factor (VWF), 300 Vulva, external genitalia, 308 W Water diffusivity, reduction, 255–256 Werner syndrome (adult progeria), 50 West Point method, usage, 399–400 Whiplash, 41 injury imaging, 362 lateral cervical spine radiograph, 363f uploaded by [stormrg] 458 INDEX White blood cells (WBCs), overproduction, 301–302 Whole-body radiation exposure, risk, 293–294 Wilms tumor (nephroblastoma), 243–244 computed tomography examination, 244f noncalcified mass, CT image, 244f staging, 244t Wound, 13 Wrist cast alignment, postreduction lateral wrist image, 374f Colles fracture, radiograph, 391f fracture, MRI scan, 378f radius, fracture (posteroanterior projection), 376f right wrist, occult, oblique, intraarticular distal radial fracture (radiograph), 390f Wrist (Continued) trauma, perilunate dislocation (radiograph), 386f volar aspect, cystic lesion (coronal MRI), 41f Z Zenker diverticulum (esophagus), 179, 180f Zygomatic arch depressed fracture, submentovertical projection, 397f fracture, 396 ... bladder before the pelvis is imaged CHAPTER 7 Urinary System 22 3 FIGURE 7-15 A computed tomography image of a FIGURE 7-16 A computed tomography image demon- CT is also useful for looking for sites... during a CHAPTER 7 Urinary System 22 7 FIGURE 7 -21 An abdominal computed tomography scan demonstrating a right percutaneous nephrostomy placement and ureteral stent radiographic procedure, and at... be palpated as an abdominal mass FIGURE 7 -24 An abdominal computed tomography image of an atrophic right kidney CHAPTER 7 Urinary System 22 9 FIGURE 7 -25 Horseshoe kidney with apparent obstruc-