AIIMS–MAMC–PGI IMAGING COURSE SERIES
PAST EDITORS
THIRD EDITION
EDITORS Veena Chowdhury MD
Director-Professor and Head Department of Radiodiagnosis Maulana Azad Medical College
New Delhi, India
Arun Kumar Gupta MD MNAMS
Professor and Head Department of Radiodiagnosis All India Institute of Medical Sciences
New Delhi, India
Niranjan Khandelwal MD Dip. NBE FICR
Professor and Head Department of Radiodiagnosis Postgraduate Institute of Medical Education and Research
Chandigarh, India
ASSOCIATE EDITORS Sanjiv Sharma MD
Professor and Head Department of Cardiac Radiology CN Center All India Institute of Medical Sciences
New Delhi, India
Anjali Prakash DMRD DNB MNAMS
Professor Department of Radiodiagnosis Maulana Azad Medical College
New Delhi, India
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Diagnostic Radiology: Chest and Cardiovascular Imaging
© 2010, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 1996
Second Edition: 2003
Third Edition: 2010
9788184488685
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
5Contributors
- Akshay Kumar Saxena md
- Associate Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Anupam Lal md
- Associate Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Anjali Prakash dmrd dnb mnams
- Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Anju Garg md
- Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Arun Kumar Gupta md mnams
- Professor and Head
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Ashu Seith Bhalla md
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Atin Kumar md mnams dnb
- Assistant Professor
- Department of Radiodiagnosis
- Trauma Centre
- All India Institute of Medical Sciences
- New Delhi, India
- Chetan Patel mbbs drm dnb (Nuclear Medicine)
- Associate Professor
- Department of Nuclear Medicine
- All India Institute of Medical Sciences
- New Delhi, India
- Deep Narayan Srivastava md mnams
- Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Gurpreet Singh Gulati md
- Associate Professor
- Cardiovascular and Interventional Radiology
- Cardiothoracic Center
- All India Institute of Medical Sciences
- New Delhi, India
- Jyoti Kumar md dnb mnams
- Assistant Professor
- Maulana Azad Medical College
- New Delhi, India
- Kushaljit Singh Sodhi md
- Assistant Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research,
- Chandigarh, India
- Madhavi Chawla mbbs dnb (Nuclear Medicine)
- Senior Research Associate
- Department of Nuclear Medicine
- All India Institute of Medical Sciences
- New Delhi, India
- Mahesh Prakash md
- Assistant Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Mandeep K Garg md frcr
- Assistant Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Mandeep Kang md
- Associate Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research, Chandigarh
- Manavjit Sandhu md
- Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Niranjan Khandelwal md dip. nbe ficr
- Professor and Head
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Naveen Kalra md
- Associate Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Priya Jagia md
- Assistant Professor
- Department of Cardiac Radiology
- All India Institute of Medical Sciences
- New Delhi, India
- Raju Sharma md mnams
- Additional Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Rashmi Dixit md
- Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Sameer Vyas md
- Senior Research Associate
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Sanjay Sharma md frcr dnb
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Sanjay Thulkar md
- Associate Professor
- Department of Radiodiagnosis (IRCH)
- All India Institute of Medical Sciences
- New Delhi, India
- Sapna Singh md dnb mnams
- Assistant Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Sanjiv Sharma md
- Professor and Head
- Department of Cardiac Radiology
- All India Institute of Medical Sciences
- New Delhi, India
- Shivanand Gamanagatti md
- Assistant Professor
- Department of Radiodiagnosis
- Trauma Centre
- All India Institute of Medical Sciences
- New Delhi, India
- Smriti Hari md
- Assistant Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Sumedha Pawa md
- Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Veena Chowdhury md
- Director Professor and Head
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Vivek Gupta md
- Assistant Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
The first edition of Diagnostic Radiology on ‘Chest and Cardiovascular Imaging’ was published in 1996. Rapid advances in the field of imaging necessitated revision and the second edition was published in 2003.
Chest Imaging continues to be one of the most important and well-established subspecialities of Radiology. Imaging of the lungs and mediastinum requires an understanding of both plain radiography as well as Computed Topography (CT) and other imaging modalities. The phenomenal technical advances in the last few years have changed the practice of chest as well as cardiovascular imaging while retaining the importance of conventional imaging. Cardiovascular imaging has transitioned nearly completely in the past two decades from dependence on X-ray angiography for definite diagnosis to noninvasive cross-sectional imaging techniques. The roles of MRI and MDCT are under rapid evolution. Continuing education is therefore essential so that multimodality imaging approach provides best patient care in a cost-effective manner.
We hope that this third edition will serve as a comprehensive updated reference book for postgraduates, practising radiologists, and chest physicians.
We wish to take this opportunity to thank our faculty from Maulana Azad Medial College, All India Institute of Medical Sciences and Postgraduate Institute of Medical Education and Research for their active contribution and support without which this endeavor would not have been possible.
We would also like to thank Shri Jitendar P Vij (Chairman and Managing Director), Mr Tarun Duneja (Director-Publishing) and Ms Samina Khan of M/s Jaypee Brothers Medical Publishers (P) Ltd, for their professional help and cooperation in publishing this book in present form.
Veena Chowdhury
Arun Kumar Gupta
Niranjan Khandelwal
Sanjiv Sharma
Anjali Prakash
9Preface to the First Edition
It is with great pleasure the faculty of Department of Radiodiagnosis at All India Institute of Medical Sciences, Maulana Azad Medical College, New Delhi, and Postgraduate Institute of Medical Education and Research, Chandigarh present the second book in the series on Diagnostic Radiology. This book is devoted to Emergency and Chest Radiology and has been written to provide the radiologist in training, in practice or teaching, physician and surgeon, an integrated review of the role of various imaging modalities and roentgen features seen in diseases of the chest and in acute emergency situations, both medical and surgical, including trauma.
The plain chest radiograph remains the initial imaging modality for various chest diseases and its interpretation continues to be a great challenge. Importance of chest radiograph in the diagnosis of various diseases has been dealt with in depth in all the chapters. Technique of CT and its recent advances in the evaluation of chest diseases and potential of MRI for evaluation of thoracic lesions are covered in separate chapters. Detailed discussion on the clinicopathological aspects and radiology in common thoracic diseases like tuberculosis, nontubercular infections and malignancy, role of HRCT in specific conditions and infections in immunocompromised hosts are included. All the chapters provide information about the recent developments in various fields.
Importance of having diagnostic technical facilities and role of a radiologist in handling the patient in acute emergency are highlighted. The increasing use of US and CT as an initial examination in the assessment of acute abdominal conditions has tended to diminish awareness of the value of plain radiography. The role of plain radiograph, US and CT in nontraumatic acute abdomen are covered in separate chapters.
Trauma is one of the leading cause of morbidity and mortality. The incidence and severity have sharply increased during the past few decades, primarily because of the increased use of high speed travel. A disciplined approach to the assessment of trauma provides confident interpretation and avoids errors of misdiagnosis. Computed tomography has revolutionized evaluation of a patient with head injury and it remains the first modality of choice. The diagnostic evaluation of patient with craniofacial injury remains problematic because of anatomic complexity of this region, wide spectrum of fracture types, and diversity of soft tissue complication. The proper approach to radiographic diagnosis of appendicular trauma begins by obtaining the appropriate radiographs of each site. Awareness of the common, the often missed and the probable associated injuries improve interpretation and make assessment of radiographs much easier.
The role of the radiologist in the management of abdominal trauma has expanded considerably in the recent years. Earlier urography, scintigraphy and angiography played an important role in trauma care. The modalities of CT and interventional radiology have improved the assessment of an injured patient and facilitated nonoperative therapy for some injuries.
The proliferation of imaging modalities has increased the possibility of performing inappropriate and unnecessary investigations. The comprehensive discussion on the indications and importance of various imaging techniques in the practice of emergency and chest radiology, a systematic approach for imaging a patient with trauma affecting different organ system are covered in this book.
We hope that the reader may find this book both instructive and informative for the improved use of radiological resources which in turn will serve the common goal of good health care for the benefit of patients everywhere.
We wish to take this opportunity to thank our faculty colleagues from AIIMS, MAMC, and PGI for their active support, cooperation and timely submission of the manuscripts. We owe immense gratitude to Prof K Subbarao and Prof Ratni B Gujral who have been kind enough to submit their contributions well in time.
Manorama Berry
Sima Mukhopadhyay
Sudha Suri