Chest Radiology: Patterns and Differential Diagnoses E-Book

Patterns and Differential Diagnoses

James C. Reed

• Publisher: Elsevier
• Year: 2017
• eBook ISBN: 9780323510219
• Edition: 7
• Topic: Medicine
• Subtopic: Radiology, Radiotherapy & Nuclear Medicine

Sharpen your skills in chest x-ray interpretation using this trusted clinical resource! Chest Radiology: Patterns and Differential Diagnoses, 7th Edition, by Dr. James Reed, walks you through a logical, sequential thought process for the differential diagnoses of 23 radiologic patterns of common chest diseases, using 150 superbly illustrated patient cases. You'll gain a solid and thorough understanding of how to read and interpret chest x-rays with expert guidance on common disease patterns, differential diagnoses, narrowing down the diagnoses, and further studies (from additional radiographic exams to CT or to biopsy). Each chapter follows a consistent format: Presenting Case, Questions, Discussion, Top 5 Diagnoses, Summary, and Answer Guide.- Heavily illustrated with chest radiographs and additional CT, HRCT, and MR correlative images; plus bulleted summary boxes of comprehensive diagnoses lists and interpretation points.- An ideal resource for mastering this lower-cost modality before considering more complicated and costly procedures.- Illustrated case studies and quizzes feature new and improved questions that address the challenges seen in practice today.- Significant updates on carcinoid tumors and pulmonary nodules, including pathologic descriptions, detection, management, and new terminology; new lung cancer screening guidelines and benefits of CT vs. x-ray for screening; and CT description of nodules, detection of pulmonary nodules with chest x-rays, anatomic and perception problems with x-rays in identifying nodules.- New content on diffuse disease, including new pathologic terms and the latest impact of high resolution CT (HRCT).- Updates on radiation dosing and emphasis on lower dosing, and an expanded emphasis on how to interpret x-rays and CT scans.- Expert Consult™ eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices.

Part 1

Chest Wall, Pleura, and Mediastinum

Outline

1. Introduction

2. Chest Wall Lesions

3. Pleural and Subpleural Opacities

4. Pleural Effusions

5. Pleural Thickening and Pleural Calcification

6. Elevated Diaphragm

7. Shift of the Mediastinum

8. Widening of the Mediastinum

9. Anterior Mediastinal Mass

10. Middle Mediastinal Mass

11. Hilar Enlargement

12. Posterior Mediastinal Mass

1

Introduction

The simplicity of performing a chest radiograph often leads to the mistaken impression that interpretation should also be a simple task. Despite the fact that the chest radiograph was one of the first radiologic procedures available to the physician, the problems of interpreting chest radiographs continue to be perplexing as well as challenging. The volume of literature on the subject indicates the magnitude of the problem and documents the many advances that have been made in this subspecialty of radiology. A casual review of the literature quickly reveals the frustrations a radiologist encounters in evaluating the numerous patterns of chest disease. There are as many efforts to define the patterns identified on chest radiographs as there are critics of the pattern approach. Because radiologists basically view the shadows of gross pathology, it is not surprising that the patterns are frequently nonspecific and that those who expect to find a one-to-one histologic correlation of the radiographic appearances with the microscopic diagnosis will be frustrated. It is much more important to develop an understanding of gross pathology to predict which patterns are likely in a given pulmonary disease. With this type of understanding of pulmonary diseases, we are better qualified to use nonspecific patterns in developing a differential diagnosis and planning the procedures required to make a definitive diagnosis.

Colonel William LeRoy Thompson of the Armed Forces Institute of Pathology first developed the concept of differential diagnosis based on radiologic findings. Later, Reeder and Felson amplified and popularized the approach in their book Gamuts in Radiology by providing an extensive list of the various patterns and the corresponding differential diagnoses.⁴⁶⁷

This manual illustrates the common patterns of chest disease to facilitate recognition. After recognition, the second step in evaluating a pattern is to develop an appropriate differential diagnosis. The complete differential diagnosis must include all of the major categories of disease (Chart 1.1) that might lead to the identified pattern. Next, the differential must be significantly narrowed by (1) careful analysis of the image for additional radiologic findings, (2) consideration of the evolving patterns of the disease by review of serial examinations, and (3) correlation of patterns with clinical and laboratory data (Chart 1.2). With this narrowed differential, we will be able to function as consultants, suggesting further procedures that may lead to a precise diagnosis. These procedures vary from simple radiographic examinations, such as those taken with the patient in oblique positions, to percutaneous biopsy under fluoroscopic, computed tomography (CT), or ultrasound guidance.

Chart 1.1 Categories of Diseases

I. Congenital/developmental

II. Inflammatory

III. Neoplastic

IV. Traumatic

V. Vascular

A. Thromboembolic

B. Cardiovascular

C. Collagen-vascular

VI. Iatrogenic

VII. Idiopathic

Chart 1.2 Algorithmic Application of Chest Patterns

A radiologist should have a thorough understanding of the radiologic differential diagnosis to determine appropriate procedures for investigating diseases of the chest. It should be obvious that the first step in evaluating many abnormalities identified on the standard posterior-anterior (PA) and lateral chest radiograph is to confirm that the abnormality is real. A newcomer to radiology frequently forgets the value of simple techniques such as reviewing examinations taken in oblique positions, PA chest radiographs with nipple markers, fluoroscopy, full chest lordotic views, and, most important, old exams. These simple procedures should be used to confirm the presence of an abnormality before considering more complicated procedures such as radionuclide scanning, arteriography, CT scanning, magnetic resonance imaging (MRI), or biopsy. In fact, the latter procedures are special procedures that should be undertaken to answer specific questions.

After deciding that an observation is a true abnormality, one of the most important radiologic decisions to be made is to localize the abnormality. Localization to soft tissues, chest wall, pleura, diaphragm, mediastinum, hilum, peripheral vessels, or the lung parenchyma is absolutely necessary before a logical differential diagnosis can be developed. Once the suspected abnormality is localized to a specific anatomic site, it is necessary to classify or describe the pattern. Some of the pa...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedication
• Preface
• Acknowledgments
• Part 1. Chest Wall, Pleura, and Mediastinum
• Part 2. Pulmonary Opacities
• Part 3. Hyperlucent Abnormalities
• Bibliography
• Index