If it is not entirely clear from conventional radiographs where and how the ossiﬁcation is occurring, a CT scan is the test of choice because of its ability to demonstrate calcium. In Case 3-8 (Figure 3-34), what is the cardiac contour abnormality? Barium sulfate suspensions are the preferred material for most examinations. On CT, hepatic laceration appears as an irregular, stellate, or linear lesion through the liver parenchyma (Figure 11-40), sometimes extending to the porta hepatis, liver capsule, or IVC (Figure 11-42). By mid-February 1896, Roentgen’s paper had not only been published but also reprinted in other scientiﬁc journals including the American journal Science. RADIOLOGY OF THE CHEST CHAPTER 4 105 Table 4-9. Multiple air bubbles (arrows) (same patient as in Figure 8-48) in the right upper quadrant indicate a subdiaphragmatic abscess. The remaining chapters focus on the individual organ systems of the heart, lungs, breast, bones, joints, abdomen, urinary tract, gastrointestinal tract, liver, biliary system, pancreas, brain, and spine. C. aortic stenosis. On ultrasound, the echogenicity of the liver is compared to the right kidney, whereas on CT, the density of the liver is compared to the 298 PART 4 ABDOMEN Figure 11-19. A challenge is that the patient is already known to have lytic bone disease. On US, they are usually homogeneous and hyperechoic (Figure 11-30 A), but an important A B Figure 11-30. Nodules with attenuation values between 0 and 200 are not necessarily malignant; they just do not have enough calciﬁcation to be categorized unequivocally as benign. CT in cholelithiasis using both soft-tissue windows (S) and bone windows (B) showing an extremely dense structure lying in the gallbladder. Also note the marginal osteophytes arising from the inferior and medial aspect of the left femoral head (arrowhead). Shoulder Dislocation The two main directions in which the proximal and humerus dislocates are anterior and posterior. 314 PART 4 ABDOMEN linear hypoechoic structures within the gallbladder wall, a positive sonographic Murphy’s sign, and marked gallbladder distention (Figure 11-54). LIVER, BILIARY TRACT, AND PANCREAS CHAPTER 11 295 Figure 11-11. Patients for whom stereotactic biopsy is being considered should be able to lie in prone position without moving for about 1 hour. (Continued) In Figure 4-14 A,B, the inferior margin of the opacity in the right upper thorax is due to A. the major ﬁssure in right upper lobe (RUL) collapse without a hilar mass. Pope T, Bloem HL, Beltran J, Morrison W, Wilson DB. They are most commonly single. B. C. D. E. Squamous-cell carcinoma Adenocarcinoma Stricture from caustic ingestion Benign peptic stricture Infectious esophageal stricture 10-4. US may be useful if CT is not available or to quickly identify intraperitoneal hemorrhage in patients who are in the emergency department 294 PART 4 ABDOMEN and are going directly to the operating room. 2008; 248:807-816. The AP view of the abdomen is also called by the acronym KUB ﬁlm because it includes the kidneys, ureters, and bladder. Sagittal T1-weighted MR image of the hindfoot reveals an avulsion of the Achilles tendon with retraction (arrow points to retracted bony fragment from the calcaneous attachment of the Achilles tendon). Another view is then obtained with the patient turned 90 degrees and the left side against the receptor and arms overhead. Shoulder Instability The glenohumeral joint is the most inherently unstable ballin-socket joint in the body. The lateral aspect of the distal tibial physis or growth plate is widened (D is the correct answer to Question 6-5). Biliary tree gas is located in the central hepatic zone near the porta hepatis. TECHNIQUES Conventional Radiography The Posteroanterior and Lateral Chest Radiograph The simplest conventional study of the chest is a posteroanterior and lateral chest radiograph taken in a radiographic 68 PART 2 CHEST unit specially designed for these studies. Clinical criteria to predict the severity or likelihood of complications of pancreatitis correlate well with the presence and extent of extrapancreatic abnormalities on imaging studies. Case 8-4. (A) Upright PA view of chest in patient with Ebstein’s anomaly reveals the globular-shaped heart characteristic of this disorder. Plain ﬁlms are most useful for the visualization of A Figure bony structures. The ventilation study is typically performed with the patient inhaling 10 to 30 mCi of xenon-133 while images are obtained with a scintillation camera (Figure 4-5A). Protons in different cerebral metabolites can be sensitively discriminated on this basis, and the position of these metabolites can be displayed as a spectrum. 11-13. The major drawback to CT for cardiac imaging at present is the use of ionizing radiation, which without careful management can be 4 to 5 times higher than for a standard chest CT. Fortunately, many techniques have been developed that lower radiation exposure. Atlas SW. Basic guidelines pertaining to technique selection for evaluating common neurologic conditions are provided. Paperback. PET-CT fused image demonstrates hypermetabolic activity in a tumor in the superior segment of the right lower lobe. 10-23. When reviewing thoracic or lumbar spine ﬁlms, attention to the soft tissues may facilitate diagnosis of a host of conditions ranging from pneumonia and lung cancer to retroperitoneal diseases and abdominal aortic aneurysms. The left atrium makes up the posterior cardiac shadow just above the left ventricle (LA in Figure 3-1). However, high cost, limited availability, and contraindications such as pacemakers and claustrophobia limit the use of routine genitourinary MR imaging. A frontal radiograph of both hips in a 35-year-old man with episodic right hip pain that began 4 to 6 months ago who presented with a dull aching pain now in both hips. A. Once airspace disease is identified, an attempt should be made to determine its cause. Note that the embryological and functionally distinct outer cortex and inner medulla are not visibly separable. Frontal view of both hands in a patient with long-standing rheumatoid arthritis showing marked carpal destruction and radiocarpal joint narrowing with substantial erosive change as well as the characteristic “bare area” erosions best exhibited at the second metacarpal phalangeal joint (arrowheads). Infection Intracranial infections are best evaluated by contrast-enhanced MR imaging. The left atrial appendage is immediately adjacent and inferior to the left main bronchus. Case 12-16. As in the SPECT study (Figure 12-10), areas of high activity correspond to metabolically active gray matter (arrows), especially the visual cortex (arrowheads). The increasing availability and technical capability of cross-sectional modalities such computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) now dominate imaging of the urinary system with multidetector (spiral) CT having the greatest impact.