Contents

Preface

Chapter 1 Introduction

Introduction

Plain films and fluoroscopy

Ultrasound

Computed tomography

Magnetic resonance imaging

Nuclear medicine

Interventional radiology

Chapter 2 Respiratory tract

Respiratory tract investigations

Normal chest

Principal types of lung shadowing

Nodulars hadowing

Consolidation

Bronchial carcinoma: peripheral

Bronchial carcinoma: central

Pulmonary metastases

Pneumonia

Tuberculosis

Bronchiectasis

Pleural effusion

Pneumothorax

Idiopathic pulmonary fibrosis

Emphysema

Pneumoconiosis

Asbestos exposure

Elevated diaphragm

Opaque hemithorax

Hilar lymphadenopathy

Lung abscess

Upper zone fibrosis

Lower zone fibrosis

Mediastinal mass

Chapter 3 Cardiovascular system

Cardiovascular investigations

Cardiomegaly

Pericardial effusion

Cardiac failure

Deep vein thrombosis

Pulmonary embolus

Abdominal aortic aneurysm

Aortic dissection

Peripheral vascular disease

Arterial embolus

Pulmonary arterial hypertension

Superior and inferior vena cava obstruction

Cardiac calcification

Tube and catheter placement

Chapter 4 Gastrointestinal tract

Gastrointestinal tract investigations

Plain abdomen film

Oesophageal web

Pharyngeal pouch

Oesophageal varices

Moniliasis

Benign oesophageal stricture

Achalasia

Oesophageal carcinoma

Hiatus hernia

Gastric outlet obstruction

Gastric carcinoma

Gastriculcer

Duodenal ulcer

Crohn’s disease

Malabsorption

Small bowel obstruction

Large bowel obstruction

Ulcerative colitis

Colonic polyps

Colonic carcinoma

Diverticular disease

Volvulus

Air under the diaphragm

Chapter 5 Liver and pancreas

Liver and pancreas: investigations

Gallstones

Common bile duct stricture

Common bile duct calculus

Additional causes of obstructive jaundice

Liver abscess

Hepatocellular carcinoma

Liver metastases

Acute pancreatitis

Chronic pancreatitis

Pancreatic carcinoma

Ascites

Subphrenic abscess

Chapter 6 Urinary tract

The urinary tract: investigations

Congenital renal abnormalities

Polycystic kidneys

Renal cyst

Renal pelvis/ureteric tumours

Renal tract obstruction

Renal artery stenosis

Renal carcinoma

Tuberculosis of the urinary tract

Unilateral non-functioning kidney

Unilateral small kidney

Nephrocalcinosis

Renal calculus

Ureteric calculus

Bladder calculus

Bladder diverticulum

Urethral stricture

Testicular carcinoma

Bladder carcinoma

Prostate carcinoma

Chapter 7 Musculoskeletal system

Skeletal system: procedures

Paget’s disease

Benign bone tumour

Malignant bone tumour

Bone metastases

Multiple myeloma

Osteoporosis

Osteoarthritis

Rheumatoid arthritis

Gout

Ankylosing spondylitis

Rickets

Osteomalacia

Osteomyelitis

Chapter 8 Trauma

Fractures

Facial bone fractures

Spinal fractures

Shoulder dislocation

Humeral neck fracture

Elbow fractures

Colles’ fracture

Scaphoid fracture

Hip fractures

Knee fractures

Ankle fractures

Foot fractures

Blunt abdominal trauma

Chapter 9 Paediatrics

Hyaline membrane disease

Congenital diaphragmatic h ernia

Pyloric stenosis

Intussusception

Hirschsprung’s disease

Vesico-ureteric reflux

Congenital dislocation of the hips

Perthes’ disease

Chapter 10 Obstetrics and gynaecology

Investigations

Uterine fibroids (leiomyoma)

Intrauterine contraceptive device

Fallopian tube occlusion

Polycystic ovaries

Gestation: 6 weeks

Gestation: 16 weeks

Fetal anomaly

Ectopic gestation

Benign ovarian cyst

Ovarian carcinoma

Chapter 11 Neuroradiology

Neuroradiology: investigations

Normal b rain CT

Normal brain MRI

Glioma

Posterior fossa tumour

Pituitary tumour

Acoustic neuroma

Meningioma

Cerebral metastases

Cerebral atrophy

Cerebral infarct

Haemorrhagic infarct

Cerebellar infarct

Lacunar infarct

Subdural haemorrhage

Extradural haemorrhage

Subarachnoid haemorrhage

Carotid artery stenosis

Multiple sclerosis

Spinal cord tumour

Spondylolisthesis

Disc prolapse

Syringomyelia

Chapter 12 Specific radiological investigations

Respiratory tract

Cardiovascular system

Gastrointestinal tract

Biliary tract

Urinary tract

Chapter 13 Film-viewing hints

Film-viewing hints

Index

This edition first published 2010, © 2010 by P. R. Patel

Previous editions: 1998, 2005

Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing programme has been merged with Wiley’s global Scientific, Technical and Medical business to form Wiley-Blackwell.

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Library of Congress Cataloging-in-Publication Data

Patel, P. R.

Lecture notes. Radiology/Pradip R. Patel. – 3rd ed.

p.; cm.

Includes index.

ISBN 978-1-4051-9514-0

1. Radiography, Medical–Outlines, syllabi, etc. I. Title. II. Title: Radiology.

[DNLM: 1. Technology, Radiologic–methods. 2. Diagnostic Imaging–methods.

WN 160 P295L 2010]

RC78.17.P385 2010

616.07′57-dc22

2010008385

A catalogue record for this book is available from the British Library.

Preface

This book is intended to be a concise introductory guide to radiology, principally for medical students, but it should also be of value to radiographers and junior doctors. The contents cover the imaging techniques, basic film interpretation and specialized radiological investigations currently available. Emphasis is on conventional plain film and contrast radiology, as it is essential that interpretation of these fundamentals is mastered before progressing to more advanced imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI). Despite recent major technological strides, conventional radiology still has a crucial role to play in the assessment of a large number of patients and it is important, therefore, that the basics of radiology be learnt to assist patient management.

Radiology has assumed a central role in the initial diagnosis as well as subsequent management of patients. The burden on the medical curriculum is continually increasing, so the format of the book is arranged such that it can be covered within a short space of time. The clinical orientation should ensure that the importance of radiology is not taken out of context with the routine care of patients, serving also as an aid to reinforce some essential background information.

The book is divided into sections by body systems, with a brief description of techniques and investigations given at the beginning of several chapters. This should assist understanding of the basic principles of the large number of available procedures for imaging a particular problem, in order that the correct investigation for each clinical situation can be chosen. Radiology is a vast subject; the essentials are presented and discussed in this book to provide a basic foundation course in radiology. For more detailed information the many excellent textbooks available should be consulted.

PRP

Chapter 1

Introduction

Introduction

Recent technological advances have produced a bewildering array of complex imaging techniques and procedures. The basic principle of imaging, however, remains the anatomical demonstration of a particular region and related abnormalities, the principal imaging modalities being:

plain X-rays: utilizes a collimated X-ray beam to image the chest, abdomen, skeletal structures, etc.;

fluoroscopy: a continuous X-ray beam produces a moving image to monitor examinations such as barium meals, barium enemas, etc.;

ultrasound (US): employs high-frequency sound waves to visualize structures in the abdomen, pelvis, neck and peripheral soft tissues;

computed tomography (CT): obtains cross-sectional computerized densities and images from an X-ray beam/detector system;

magnetic resonance imaging (MRI): exploits the magnetic properties of hydrogen atoms in the body to produce images;

nuclear medicine (NM): acquires functional as well as anatomical detail by gamma radiation detection from injected radioisotopes.

Contrast media

Contrast agents are substances that assist visualization of some structures during the above techniques, working on the basic principle of X-ray absorption, thereby preventing their transmission through the patient. The most commonly used are barium sulphate to outline the gastrointestinal tract, and organic iodine preparations, the latter widely used intravenously in CT for vascular and organ enhancement. Contrast agents can also be introduced into specific sites, for example:

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