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Differential Diagnosis in Radiology
Satish K Bhargava, Sumeet Bhargava
CHAPTER 1:
Chest
1.1 LESIONS OF THORACIC INLET
Anatomy of Thoracic Inlet
Differential Diagnosis of Lesions at Thoracic Inlet
Lymphangioma
Hemangiomas
Cervical Extension of Mediastinal Thymus
Thymic Cyst
Vascular Anomalies
Cervical Abscess
Tuberculous Spondylitis with Abscess Formation
Retropharyngeal Abscess with Mediastinal Extension
Causes of Retropharyngeal Abscess
Lipoma
Lipoblastoma
Schwannomas and Neurofibromas
Aggressive Fibromatosis
Lymphoma
Thyroid Carcinoma
Neuroblastoma
Pancoast's Tumor
Pneumomediastinum
Cervicothoracic Hematoma
Causes
Computed Tomography (CT)
Cervical Rib
Thoracic Outlet Syndrome
Usual Causes
Intrathoracic Goiter
CYSTIC LYMPHANGIOMA
Thymic Cyst
Cervical Abscess
Pott's Spine with Abscess
SOLID WITH FAT DENSITY (FLOW CHART 1.1)
Lipoma
Liposarcoma
Lipoblastoma
SOLID WITHOUT FAT DENSITY
Neuroblastoma
Thyroid Carcinoma
Pancoast's Tumor
Metastatic Lymph Node Mass
Others
Hemangioma
Cervical Rib
1.2 MEDIASTINAL MASSES (TABLE 1.1)
Mediastinum
Thymic Tumors
Commonest Tumors of Mediastinum (Table 1.1)
Teratodermoid Tumors
PLEUROPERICARDIAL CYST
DIFFERENTIAL DIAGNOSIS OF SOFT TISSUE LESIONS IN RIGHT ANTERIOR CARDIOPHRENIC ANGLE (TABLE 1.4)
Morgagni Hernia
MIDDLE MEDIASTINAL MASSES
Lymph Node Enlargement
Metastatic (Table 1.3)
Aortic Aneurysm (Fig. 1.4)
Tortuous Innominate Artery
Bronchogenic Cyst
Tracheal Tumors
POSTERIOR MEDIASTINAL MASSES
Neurogenic Tumors (Table 1.5)
Adults
Children
HIATUS HERNIA
ESOPHAGEAL LESIONS
PARAVERTEBRAL LESIONS
Bochdalek Hernia
Neurenteric Cysts
Pancreatic Pseudocyst
1.3 SUPERIOR MEDIASTINAL MASSES—DIFFERENTIAL DIAGNOSIS
Contents
Criteria for Superior Mediastinum Widening
1.4 DIFFERENTIAL DIAGNOSIS OF ANTERIOR MEDIASTINAL MASS
Salient Features
Region 1 (Fig. 1.7)
Region 2
Region 3
1.5 ANTERIOR MEDIASTINAL MASS
Children
Congenital
Lymphoma
ANTERIOR MEDIASTINAL MASS
Adults
Lymphoma
Thymoma
Thyroid
Lipoma
MIDDLE MEDIASTINAL MASSES
Children
Adult
LYMPH NODES
Neoplastic
Hodgkin's Disease
Non-Hodgkin's Disease
Inhalation Disease
Foregut Duplication Cyst
Esophageal Duplication Cyst
Neurenteric Cyst
Cystic Hygroma
Thoracic Aortic Aneurysm
Other Arterial Abnormalities
Venous Abnormality
Metastasis
Inflammatory
Sarcoidosis (Fig. 1.8)
1.6 D/D POSTERIOR MEDIASTINAL MASSES
Mediastinum (Fig. 1.9)
DDs
Neurenteric Cyst
Pertechnetate Scan
Dilated Azygous Vein
Esophageal Lesions
Paravertebral Lesions
Bochdalek's Hernia
Neurogenic Tumors
Hiatus Hernia
1.7 CHEST WALL ABNORMALITIES (TABLE 1.7)
Pectus Excavatum
Pectus Carinatum
Cervical Rib
Cleidocranial Dysostosis
Poland Syndrome
Inflammatory and Infectious Disease
Tumors of Chest Wall
Radiological Differentiation of Chest Wall Tumors
Benign
Malignant
1.8 SUPERIOR RIB NOTCHING
Classification (Sargent et al)
Salient Features
Poliomyelitis
Rheumatoid Arthritis
Systemic Sclerosis
Systemic Lupus Erythematosus (SLE)
Osteochondroma
Neurofibromatosis
Marfan's Syndrome
Osteogenesis Imperfecta
Hyperparathyroidism
1.9 INFERIOR RIB NOTCHING
Unilateral
Bilateral
Pleural Effusion (Fig. 1.11 and Table 1.8)
1.10 ELEVATION OF DIAPHRAGM
Small Hilum (Table 1.9)
Unilateral
Bilateral
Unilaterally Elevated Diaphragm
Bilaterally Elevated Diaphragm
Pneumothorax
Pneumomediastinum
1.11 PNEUMOMEDIASTINUM
Right-sided Diaphragmatic Humps
At any site
Medially
Anteriorly
Posteriorly
1.12 LUNG TUMORS
Metastases
Cavitatory Metastases
Calcifying Metastases
Endobronchial Metastases
Lymphangitis Carcinoma
Hodgkin's/Non-Hodgkin's Lymphoma
Leukemia
Sarcoma
Adenoma
Hamartoma
Lung Abscess
Bronchiectasis
Asthma
Chronic Bronchitis
Emphysema (Fig. 1.13)
Bronchiolitis
1.13 HILAR ENLARGEMENT (TABLES 1.11 AND 1.12)
Unilateral Hilar Enlargement (Fig. 1.11)
Bilateral Hilar Enlargement
APICAL SHADOWS (TABLE 1.13)
1.14 CALCIFICATION ON CHEST RADIOGRAPH
Intrapulmonary (Figs 1.15 and 1.16)
Lymph Nodes
Pleural
Mediastinal
Pulmonary Artery
Chest Wall
1.15 AIR-FLUID LEVELS ON CHEST X-RAY
Crescent Sign
1.16A CAVITATING PULMONARY LESIONS
Infection
Malignant
Abscess
Collagen Diseases
Developmental
1.16B MASS WITHIN CAVITY (TABLE 1.14)
1.17 CAVITATING PULMONARY LESIONS
Causes
Carcinoma
Primary
Mechanism
Metastasis—Cavitation
Hodgkin's Disease
Tuberculosis
Staphylococcus aureus
Hydatid Cysts
Aspergillosis
Abscess (Aspiration)
Pulmonary Infarct
Cystic Bronchiectasis (Fig. 1.17)
Sequestered Lung
Wegener's Granulomatosis
Rheumatoid Nodules
Progressive Massive Fibrosis
Sarcoidosis
Infected Emphysematous Bullae
TRAUMA
Hematoma—peripheral
Traumatic Lung Cyst
Bronchogenic Cyst
Cystic Adenomatoid Malformation
1.18A LUCENT LUNG LESIONS
Multiple Lucent Lung Lesions
Cavities
Neoplasm
Vascular
Cysts
Differential Features are same as Localized Lucent Defects (Table 1.15)
1.18B SOLITARY PULMONARY NODULE
1.19 SOLITARY PULMONARY NODULE (TABLE 1.16)
Definition (Fig. 1.19)
Neoplasm
Infection
Inflammatory
Vascular
Airway
Characteristics of SPN
CT Nodule Enhancement
Pulmonary Hamartomas
Inflammatory Pseudotumor (Plasma Cell Granuloma)
Bronchial Carcinoid
Bronchial Carcinoma (Fig. 1.22)
Metastasis
Tuberculoma
Hydatid Cyst
Histoplasmoma
Pneumonia
Lung Abscess
Cavitary Lesion with Adjacent Consolidation
Wegener's Granulomatosis
Rheumatoid Nodules
Pulmonary A-V Fistula
Pulmonary Artery Aneurysm
Pulmonary Hematoma
Pulmonary Infarct
Bronchogenic Cyst
1.20 PULMONARY EDEMA ON THE OPPOSITE SIDE TO A PRE-EXISTING ABNORMALITY (TABLE 1.17)
Localized Air Space Disease
Unilateral Pulmonary Edema
Alveolar Shadowing
Acute
Chronic
Characteristics
Air Bronchogram
Common
Rare
Mesothelioma
Pneumonectomy
Pulmonary Agenesis
Differential Diagnosis (D/D) Diaphragmatic Hernia
Consolidation
Collapse
Fibrosis
Cardiomegaly
1.21A MILIARY SHADOWING
D/D Miliary Shadowing
Interstitial (Fig. 1.24)
Miliary Shadowing
Causes
Miliary Tuberculosis (Fig. 1.25)
Histoplasmosis
Silicosis
Coal Miner's Pneumoconiosis
Sarcoidosis
Histiocytosis X
Miliary Metastasis
Hemosiderosis
Alveolar Microlithiasis
1.21B MILIARY SHADOWING (0.5 TO 2 MM)
Pneumoconiosis
Silicosis
Coal Workers
Asbestosis (Fig. 1.26)
Berylliosis
1.22 MULTIPLE PINPOINT OPACITIES (TABLES 1.18 AND 1.19)
Septal Lines
1.23 COMPLETE OPAQUE HEMITHORAX
Causes (Figs 1.27 and 1.28)
Diaphragmatic Hernia
Effusion
1.24 OPAQUE HEMITHORAX
Causes
Rotation
Pleural Effusion
Exclude Carcinoma Bronchus
Agenesis
Aplasia
Hypoplasia
Diaphragmatic Hernia
Consolidation
Pleural Thickening
Fibrothorax is defined by Criteria
Mesothelioma
Post-pneumonectomy
1.25 HYPERTRANSRADIANT LUNG FIELD
Pneumothorax
Plain Skiagram Chest
Congenital Lobar Emphysema
Pulmonary Arterial Hypoplasia
1.26 HYPERTRANSLUCENT LUNG FIELD
Causes of Bilateral Hypertranslucency
Faulty Radiologic Technique
Decreased Soft Tissues
Cardiac Cause
Pulmonary Cause
Localized Lucent Lung Defect
1.27A HONEYCOMB LUNG
Multiple Pinpoint Opacities
Lobar Pneumonia (Fig. 1.30)
Consolidation with Bulging Fissures
Lung Disease Associated with Honey Combing
Collagen Disorders
1.27B HONEY COMB PATTERN
Causes
Rheumatoid Arthritis
Scleroderma
ASBESTOSIS
Silicosis
Extrinsic Allergic Alveolitis
Sarcoidosis
Langerhans Cell Histiocytosis
Usual Interstitial Pneumonitis/ Cryptogenic Fibrosing
Alveolitis
Tuberous Sclerosis
Neurofibromatosis
1.28 PLEURAL DISEASES
Pleural Thickening
Infection
Tuberculosis (TB)
Inhalation Disorder
Neoplasm
Pleural Calcification
Pleural Masses
Benign
Malignant Pleural Thickening
Malignant Mesothelioma
Pneumothorax
Hemothorax
Open
Closed
1.29 PLEURAL FLUID
Radiological Appearances of Pleural Fluid
Pneumothorax (Fig. 1.32)
1.30 PLEURAL TUMORS
1.31 PLEURAL CALCIFICATION (FLOW CHART 1.3)
Old Empyema and Old Hemothorax
Asbestos Inhalation
Malignant Mesothelioma
Extrathoracic Manifestation
Silicosis
Other Features
1.32 HIGH RESOLUTION CT-PATTERN OF PARENCHYMAL DISEASE
Peripheral, Base
Central Upper Fluid Zones
Peripheral and Central
Widespread
1.33 CARDIOPHRENIC ANGLE MASS (FLOW CHART 1.4)
Hydatid Cyst
Morgagni Hernia
Diaphragmatic Hump and Hernia
Congenital Hernia
Scimitar Syndrome
Fibrous Tumors of Pleura
Primary or Secondary Carcinoma
Epicardial Fat Pad
Lipoma
Lymph Nodes
Causes of enlargement are:
CHAPTER 2:
Breast—Mammographic Differential Diagnosis
2.1 CIRCUMSCRIBED RADIOLUCENT LESION (FLOW CHART 2.1)
Mixed Density Lesions
Galactocele
Hematoma
Lymph Node
Causes
Radiopaque (Soft Tissue Density Lesion)
Simple Cyst (Fig. 2.1)
Fibroadenoma (Figs 2.2 to 2.4)
Papilloma
Phylloides Tumor (Cystosarcoma Phylloides)
Metastasis
Lymphoma
Circumscribed Malignant Lesions (Circumscribed Carcinoma)
Spiculated Breast Masses (Figs 2.6 and 2.7)
Post-surgical Scar
Fat Necrosis
Radial Scar (Complex Sclerosing Lesion)
Breast Abscess
Sclerosing Adenosis
Pseudomass (Summation Shadows)
The Edematous Breast (Fig. 2.8)
Differential Diagnosis
BREAST CALCIFICATIONS (FIG. 2.9)
Characteristically Benign Calcification
Calcification Suspicious for Malignancy
Malignant (Fig. 2.10)
Calcification
Definitely Benign
Probably Benign
Possibly Malignant—Biopsy is Indicated (see Fig. 2.10)
Benign Conditions that Mimic Malignancy
CARCINOMA
Primary Features
Secondary Features (Fig. 2.11)
CHAPTER 3:
Cardiovascular System
3.1 DIFFERENTIAL DIAGNOSIS OF CARDIOVASCULAR DISORDERS
3.2 INVISIBLE MAIN PULMONARY ARTERY
Underdeveloped Main Pulmonary Artery (Table 3.1)
Misplaced Pulmonary Artery
3.3 PULMONARY ARTERIAL HYPERTENSION (FIG. 3.1)
3.4 ENLARGED LEFT VENTRICLE (ELV)
Volume Overload
Pressure Overload
High Output States
Myocardial Causes
3.5 ENLARGED LEFT ATRIUM
Volume Overload (Table 3.2)
Mitral Regurgitation
Pressure Overload (Table 3.3)
Secondary to Left Ventricular Failure
3.6 DILATATION OF PULMONARY TRUNK
3.7 ENLARGEMENT AORTA
3.8 SMALL AORTA
3.9 ENLARGED RIGHT ATRIUM (TABLE 3.4)
3.10 ENLARGED RIGHT VENTRICLE (TABLE 3.5)
3.11 RIGHT AORTIC ARCH
Transposition of Great Vessels
Causes
3.12 PULMONARY VENOUS HYPERTENSION
3.13 ENLARGED SUPERIOR VENA CAVA
3.14 CARDIAC CALCIFICATIONS
3.15 CARDIAC VALVE CALCIFICATIONS
3.16 SITUS
3.17 CYANOTIC HEART DISEASE
CHAPTER 4:
Soft Tissue Lesions
4.1 DIFFERENTIAL DIAGNOSIS OF SOFT TISSUE LESIONS
4.2 SOFT TISSUE OSSIFICATION
Formation of Trabecular Bone
Myositis Ossificans
Liposarcoma
Parosteal Osteosarcoma
Burns
Paraplegia
Congenital Myositis Ossificans Progressiva
Tumoral Calcinosis
Surgical Scar
4.3 LINEAR CALCIFICATION OF SOFT TISSUES
4.4 PARASITIC CALCIFICATION (TABLE 4.1)
4.5 AREAS OF DECREASED DENSITY
4.6 PERIARTICULAR SOFT TISSUE CALCIFICATION
4.7 GENERALIZED CALCINOSIS
Scleroderma
Dermatomyositis
Idiopathic Tumoral Calcinosis
Idiopathic Calcinosis Universalis
4.8 SHEET-LIKE CALCIFICATION IN SOFT TISSUE (TABLE 4.2)
CHAPTER 5:
Abdomen and Gastrointestinal Tract and Hepatobiliary System
5.1 DILATED ESOPHAGUS
Normal versus Abnormal Appearance of Esophagus
Strictures
Peptic Stricture
Barrett's Esophagus
Scleroderma
Other Associated Features
Corrosives
Achalasia (Figs 5.1 and 5.2)
Causes
Leiomyomas
Carcinoma Esophagus
Types
Annular/Eccentric
Chest X-ray
Computed Tomography (CT)
Esophageal Lymphoma (Rare)
Invasion
Secondary Esophageal Neoplasms
Others
Radiological Features
Radiation Esophagitis
5.2 ESOPHAGEAL CARCINOMA
Predisposing Factors
Pathology
Gross
Histology
Japanese Society of Esophageal Disease
Distribution
Routes of Spread
Clinical Aspects
Radiographic Findings
Advanced Carcinoma
Computed Tomography (CT)
Sub-diaphragmatic Lymphadenopathy
MRI
Endoscopic Ultrasound
Differential Diagnosis of Esophageal Carcinoma
Early Esophageal Carcinoma
Advanced Carcinoma
5.3 THICKENED MUCOSAL FOLDS ESOPHAGUS AND STOMACH
Thickened Esophageal Folds
Causes
THICKENED GASTRIC FOLDS
Thickened Duodenal Folds
Ulcer Disease
THICKENED SMALL BOWEL
Folds (Flow chart 5.2 and Fig. 5.5)
5.4 THICKENED GASTRIC FOLDS
5.5 THICKENED DUODENAL FOLDS
5.6 MASSIVELY DILATED STOMACH
5.7 TARGET LESIONS IN STOMACH ON BARIUM STUDIES (FIG. 5.7)
5.8 GAS IN GASTRIC WALL
5.9 COBBLE STONE DUODENAL CAP ON BARIUM STUDY (FIG. 5.9)
5.10 DILATED DUODENUM/OBSTRUCTION OF DUODENUM
5.11 DILATED SMALL BOWEL/JEJUNAL AND ILEAL OBSTRUCTION
Criteria
5.12 STRICTURES SMALL BOWEL
5.13 SMALL INTESTINAL STRICTURE
Differential Diagnosis (Flow chart 5.3)
Tuberculosis (Figs 5.11A and B)
Crohn's Disease
Metastatic Carcinoma
Eosinophilic Enteritis
Post-traumatic
Drug Induced
Primary Malignancy
Radiation Enteritis
Endometriosis
5.14 THICKENED FOLDS IN SMALL BOWEL (FLOW CHART 5.2)
Localized (< 50% of small bowel)
Smooth and Regular
Irregular and Distorted
Generalized (> 50% small bowel involved)
Smooth and Regular
Irregular and Distorted
5.15 THICKENED SMALL BOWEL FOLDS WITH GASTRIC ABNORMALITY
5.16 NODULAR APPEARANCE OF SMALL BOWEL
5.17 MALABSORPTION
5.18 MALABSORPTION
5.19 PROTEIN LOSING ENTEROPATHY
5.20 PATHOLOGIC LESIONS IN TERMINAL ILEUM
5.21 COLONIC POLYPS
5.22 COLONIC POLYPS
Adenomatous
Hyperplastic
Hamartomatous
Inflammatory
Infective
Others
5.23 COLONIC STRICTURES/NARROWING
5.24 PNEUMATOSIS INTESTINALIS
5.25 MEGACOLON IN ADULTS
Radiological Findings
5.26 THUMB PRINTING IN COLON (FIG. 5.14)
5.27 APHTHOUS ULCERS
5.28 ANTERIOR INDENTATION OF RECTOSIGMOID JUNCTION
5.29 WIDENING/ENLARGEMENT OF PRESACRAL/RETRORECTAL SPACE
5.30 CYSTIC MESENTERIC MASSES
5.31 NONVISUALIZATION OF GALLBLADDER ON ULTRASOUND
Filling Defects In Gallbladder
5.32 GAS IN BILIARY TREE
5.33 GAS IN PORTAL VENOUS
5.34 DIFFUSE HEPATOMEGALY
5.35 HEPATIC CALCIFICATION
5.36 PRIMARY HEPATIC MASSES
5.37 NEONATAL OBSTRUCTIVE JAUNDICE
5.38 FETAL/NEONATAL HEPATIC CALCIFICATION
5.39 DIFFUSELY HYPOECHOIC LIVER
5.40 DIFFUSELY HYPERECHOIC LIVER (BRIGHT LIVER)
5.41 FOCAL, HYPERECHOIC HEPATIC LESIONS
5.42 FOCAL, HYPOECHOIC, HEPATIC LESIONS
5.43 PERIPORTAL HYPERECHOGENICITY
5.44 THICKENED GALLBLADDER WALL
5.45 FOCAL HYPODENSE LESIONS ON NECT LIVER
5.46 HYPERPERFUSION ABNORMALITIES OF LIVER
5.47 HEPATIC TUMORS WITH VASCULAR “SCAR”
5.48 DIFFUSELY HYPODENSE LIVER ON NECT
5.49 SPLENOMEGALY
5.50 SPLENIC CALCIFICATION
5.51 HYPERECHOIC SPLENIC LESION
5.52 FOCAL HYPOATTENUATING LESIONS IN SPLEEN
5.53 PANCREATIC CALCIFICATION
5.54 PANCREATIC MASSES
Imaging
USG
Doppler
NECT
CECT
Other Features
Criteria for Unresectability
TNM staging
Endoscopic Ultrasound
Advantages
Disadvantages
Solid and Papillary Epithelial Neoplasm
Lymphoma
Metastasis
5.55 FOCAL PANCREATIC MASSES
5.56 ADRENAL MASS
5.57 ADRENAL CALCIFICATION
Child
Adults
5.58 EXTRALUMINAL INTRA-ABDOMINAL GAS
5.59 PNEUMOPERITONEUM
Signs on a Supine Film
Etiology
Pseudopneumoperitoneum
5.60 PNEUMOPERITONEUM (FLOW CHART 5.4)
5.61 GASLESS ABDOMEN
CHARACTERIZED BY GROUND GLASS HAZINESS IN ABDOMINAL RADIOGRAPH WITH NORMAL PROPERITONEAL FAT LINES OR BULGING OF FLANK LINES IN SOME CASES
5.62 ASCITES
Radiographic Signs
Technique
Causes
Increased Pressure in the Vascular System
Lymphatic Obstruction
5.63 ABDOMINAL MASS IN NEONATE
5.64 ABDOMINAL MASS IN CHILD
5.65 INTESTINAL OBSTRUCTION IN NEONATE
5.66 ABNORMALITIES OF BOWEL ROTATION
5.67 INTRA-ABDOMINAL CALCIFICATION IN NEONATE
5.68 HEMATEMESIS
5.69 DYSPHAGIA IN ADULTS
5.70 NEONATAL DYSPHAGIA
5.71 PHARYNGEAL/ESOPHAGEAL DIVERTICULA
Esophageal
Intramural Pseudodiverticulosis
5.72 ESOPHAGITIS/ESOPHAGEAL ULCERS
Signs of Esophagitis
Part of Esophagus involved
Features
Comments/Additional features
Part of Esophagus involved
Features
Comments/Additional features
Part of Esophagus involved
Features
Comments/Additional features
Part of Esophagus involved
Features
Comments/Additional features
Part of Esophagus involved
Features
Comments/Additional features
Part of Esophagus involved
Features
Comments/Additional features
Part of Esophagus involved
Features
Comments/Additional features
Part of Esophagus involved
Features
Comments/Additional features
Part of Esophagus involved
Features
Comments/Additional features
Part of Esophagus involved
Features
Comments/Additional features
5.73 ESOPHAGEAL STRICTURES
5.74 TERTIARY CONTRACTIONS IN ESOPHAGUS
5.75 GASTRIC MASSES AND FILLING DEFECTS
5.76 LINITIS PLASTICA
Differential Diagnosis
Radiological Appearance
Common Etiologies
5.77 LINITIS PLASTICA
5.78 GASTROCOLIC FISTULA
5.79 RETROPERITONEAL FIBROSIS
Differential Diagnosis (D/D)
Causes
Benign
Infection
Miscellaneous
Malignant
Primary Retroperitoneal Tumor
Metastasis
Lymphoma
Malignant
5.80 MASS OF ILIO-PSOAS COMPARTMENT
Imaging
Salient features
5.81 ANATOMY OF LIVER, BILE DUCTS AND PANCREAS
Functional Segmental Liver Anatomy
Functional Segmental Liver Anatomy
Hepatic Arterial Anatomy (Michel's classification)
Hepatic Fissures
Normal Size of Liver
Normal Hemodynamics Parameters of Liver
Liver Function Tests
Normal Size of Bile Ducts
Bile Duct Variants
Incidence
Pancreaticobiliary Junction Variants
CONGENITAL GALLBLADDER ANOMALIES
Agenesis of Gallbladder
Incidence
Associated with:
Hypoplastic Gallbladder
Septations of Gallbladder
Gallbladder Ectopia
Most frequent locations
Rare locations
Pancreas
Pancreatic development and anatomy
Spleen
Iron Metabolism
Deposition
5.82 INFLAMMATORY BOWEL DISEASE (IBD)
Etiology and Pathogenesis
Diet
Clinical findings
Radiologic findings
Findings
Acute Changes
Chronic Changes
Proctitis
Ultrasound
Computed Tomography
MRI
Scintigraphy
Prognosis
Crohn's Disease
Epidemiology
Risk factors
Pathogenesis and Etiology
Clinical features
Radiologic Findings
Plain film
Barium examination
Intermediate disease
Advanced disease
Anorectal disease
Computed Tomography (CT)
Ultrasonography (USG)
Transabdominal Ultrasound
Magnetic Resonance Imaging (MRI)
Extraintestinal Complications of Inflammatory Bowel Disease (IBD)
Urinary tract complications
CHAPTER 6:
Skeletal System and Joints
6.1 ABNORMAL SKELETAL MATURATION
Skeletal Maturation Disorders
Retarded
Accelerated
Asymmetric
Premature closure of growth plate
6.2 SHORT LIMB SKELETAL DYSPLASIA
Rhizomelic
Mesomelic
Acromesomelic
Acromelic
6.3 SHORT SPINE SKELETAL DYSPLASIA
6.4 LETHAL NEONATAL DYSPLASIA
6.5 DUMB-BELL-SHAPED LONG BONES
6.6 MUCOPOLYSACCHARIDOSES AND MUCOLIPIDOSIS (FIG. 6.4)
6.7 MUCOLIPIDOSES
6.8 GENERALIZED OSTEOSCLEROSIS
Children
Adults
6.9 SCLEROTIC BONE LESIONS
Developmental
Vascular
Traumatic
Infective
Idiopathic
Neoplastic
6.10 BONE SCLEROSIS ASSOCIATED WITH PERIOSTEAL REACTION
Traumatic
Neoplastic
Infective
Idiopathic
6.11 SOLITARY SCLEROTIC LESION WITH LUCENT CENTER
Neoplastic
Infective
6.12 COARSE TRABECULAR PATTERN OF BONE
6.13 RELATIONSHIP OF METASTATIC LESIONS TO THE PRIMARY TUMORS
6.14 CHILDHOOD TUMORS METASTASIZING TO BONE (TABLE 6.13)
6.15 BUBBLY BONE LESIONS
Neoplastic
Benign
Malignant
Infection
Endocrinal
Tumor-like lesions
Idiopathic
6.16 PRIMARY BONE TUMORS: CLINICAL FEATURES, SITE OF PREDILECTION, RADIOLOGIC PRESENTATION (FIGS 6.19 TO 6.27)
6.17 RADIOLOGIC CHARACTERISTICS OF BENIGN AND MALIGNANT BONE LESIONS
6.18 SUBARTICULAR LYTIC BONE LESION
Arthritides (Figs 6.28 to 6.38)
Neoplastic
Miscellaneous
6.19 OSTEOLYTIC DEFECT IN THE MEDULLA
Well-Defined
Ill-defined
6.20 LUCENT BONE LESION CONTAINING BONE/CALCIUM
Neoplastic
Miscellaneous
6.21 COMMON LYTIC BONE LESIONS
With Marked Sclerosis
Multiple
Seen in <30 years of age
Seen on both sides of joint
6.22 LOCATION OF SOME COMMON NEOPLASMS/LESIONS
Epiphysis
Metaphysis
Diaphysis
6.23 SEPTATED BONE LESIONS
6.24 MOTH-EATEN BONE
6.25 OSTEOPENIA
Generalized (Fig. 6.46 and 6.47)
Causes of Osteomalacia
Localized/Regional
6.26A PERIOSTEAL REACTIONS-TYPES AND CONDITIONS
Continuous
Causes
Patterns
Interrupted
Complex
6.26B TYPES OF PERIOSTEAL REACTIONS
Solitary and Localized
Bilateral Involvement
6.27 PERIOSTEAL REACTION IN CHILDHOOD (FIGS 6.52A TO D)
Benign
Malignant
6.28 HYPERTROPHIC OSTEOARTHROPATHY
Pulmonary
Pleural
Cardiovascular
Gastrointestinal
6.30 BONE DYSPLASIAS—ASSOCIATED WITH MULTIPLE FRACTURES
Reduced Density
Normal Osseous Density
Increased Density
6.31 EXCESSIVE CALLUS FORMATION
Causes
6.32 BONE WITHIN BONE APPEARANCE
Causes
6.33 FATIGUE FRACTURES
6.34 PSEUDOARTHROSIS
Causes
6.35 IRREGULAR/STIPPLED EPIPHYSIS (FIG. 6.54)
Causes
6.36 AVASCULAR NECROSIS/OSTEONECROSIS/ASEPTIC NECROSIS
Causes
Steinberg Classification for AVN of Hip
MR Changes in AVN (Mitchell Staging)
6.37 SOLITARY RADIOLUCENT METAPHYSEAL BANDS
Causes
6.38 SOLITARY DENSE METAPHYSEAL BAND
6.39 ALTERNATING RADIOLUCENT/DENSE METAPHYSEAL BANDS
6.40 DENSE VERTICAL METAPHYSEAL LINES
6.41 FRAYED METAPHYSIS
6.42 CUPPING OF METAPHYSIS
6.43 ERLENMEYER FLASK DEFORMITY
Causes
6.44 EROSION OF MEDIAL METAPHYSES OF PROXIMAL HUMERUS
6.45 ABNORMALITY RELATED TO CLAVICLES
Erosion or Absence of Outer End of Clavicle
Penciled Distal End of Clavicle
Destruction of Medial End of Clavicle
6.46 RIB LESIONS
Neoplastic
Non-neoplastic
6.47 RIB NOTCHING
Superior Margin
Inferior Margin
6.48 ABNORMAL SHAPE, SIZE AND DENSITY OF RIBS
6.49 MADELUNG DEFORMITY
Causes
6.50 CARPAL FUSION
Isolated
Syndrome Related
6.51 ABNORMAL DIGITS
6.52 ABNORMAL THUMB
6.53 LYTIC LESION IN DIGITS
Well-Defined
Malignant
Poorly Defined
6.54 ACRO-OSTEAL CHANGES
Acro-Osteolysis (Fig. 6.59)
Acro-osteosclerosis
Resorption of Distal Phalanges
6.55 MONOARTHRITIS
6.56 ARTHRITIS WITH PERIOSTITIS
Causes
6.57 ARTHRITIS WITH DEMINERALIZATION
Causes
6.58 ARTHRITIS WITHOUT DEMINERALIZATION
Causes
6.59 ARTHRITIS WITH PRESERVED/ WIDENED JOINT SPACE
Causes
Arthritis With Soft Tissue Nodules
Loose Intra-articular Bodies (Figs 6.62A and B)
Arthritis Mutilans
Causes
6.60 ENLARGED FEMORAL INTER-CONDYLAR NOTCH
Causes
6.61 PLANTAR CALCANEAL SPUR
Causes
6.62 CHONDROCALCINOSIS
6.63 ANKYLOSIS OF INTERPHALANGEAL JOINTS
Causes
6.64 ENTHESIOPATHY
Causes
6.65 SACROILIITIS
Unilateral
Bilateral
6.66 PROTRUSIO ACETABULI
Causes
Unilateral
Bilateral
6.67 WIDENING OF SYMPHYSIS PUBIS (DIASTASIS)
Normal Measurements
Congenital
Acquired
6.68 FUSION OF SYMPHYSIS PUBIS
Causes
6.69 RADIOGRAPHIC FINDING IN DEGENERATIVE, INFLAMMATORY AND NEUROPATHIC ARTHRITIS
6.70 COMPARATIVE FEATURES OF SERONEGATIVE SPONDYLOARTHRITIDES
6.71 D/D OF DWARFISM
Osteochondrodysplasias—Short Limb Dysplasias
Short Spine Type
Dysostosis Multiplex (Short Limb) + Short Trunk
Chromosomal Aberration
Primordial Dwarfism
Endocrine Disease
Metabolic Disorder
Primordial Dwarfism
Endocrine Disorders
Hypopituitarism
Cretinism
Hypergonadism
Turner's Syndrome
Metabolic Disorders
Hypophosphatasia
Rickets
DYSPLASIAS
Rhizomelic
Achondroplasia
Hypochondroplasia
Pseudoachondroplasia
THANATOTROPIC DWARFISM
Chondrodysplasia Punctata
MESOMELIC DWARFISM
Dyschondrosteosis (Léri-Weill Disease)
ACROMESOMELIC DWARFISM
ACROMELIC DWARFISM
Asphyxiating Thoracic Dystrophy
Short Spine Dysplasias
Diastrophic Dwarfism
Metatrophic Dwarfism
Short Limb + Short Trunk Dwarfs
Dysostosis Multiplex
Hunter's Syndrome
Brailsford-Morquio's Syndrome
Maroteaux Lamy Syndrome
6.72 SCLEROTIC LESIONS OF BONE
Imaging
Role of Radiologist
SALIENT FEATURES
Osteopetrosis
Spine
Extremities
Pyknodysostosis
Skull
Spine
Extremities
Fibrous Dysplasia
Renal Osteodystrophy and Hyperparathyroidism
Hypopseudohypo and Pseudopseudohypoparathyroidism
Osteosclerotic Metastasis
Carcinoma Prostate
Caffey's Disease
Idiopathic Hypercalcemia of Infancy
Hypervitaminosis—A, D
Fluorosis
Lead
Paget's Disease
Myeloma
Lymphoma
Myelosclerosis
Mastocytosis
Bone Island and Osteopoikilosis
OSTEOMA
OSTEOBLASTOMA
OSTEOSARCOMA (Fig. 6.68)
Rare Variants
OSTEOMYELITIS
BONE INFARCTS (Fig. 6.69)
6.73 LYTIC LESION IN BONE
EXPANSILE BONE LESION
GEODE
BRODIE'S ABSCESS
Tunneling
FIBROUS DYSPLASIA (FD)
Radiological Features
IMPLANTATION DERMOID
Age
Clinical Presentation
SOLITARY BONE CYST
Radiological Features
CHONDROBLASTOMA
ENCHONDROMA
ADAMENTINOMA OF LONG BONES
Eosinophilic Granuloma
BROWN TUMOR OF HYPERPARATHYROIDISM
MULTIPLE MYELOMA (PLASMACYTOMA)
METASTASES (FIG. 6.72)
GCT (OSTEOCLASTOMA) OR GIANT CELL TUMOR (FIG. 6.73)
ABC (Aneurysmal Bone Cyst) (Fig. 6.74)
Chondromyxoid Fibroma
Radiological Features
Bone Scan
Metastatic Neuroblastoma (Fig. 6.75)
NON-OSSIFYING FIBROMA
6.74 D/D OF GENERALIZED OSTEOPOROSIS
Osteopenia
Causes of Diffuse Osteopenia
Generalized Osteoporosis
Osteoporosis
Roentgenological Changes
Senile Osteoporosis
Etiology
Juvenile Osteoporosis
Postmenopausal Osteoporosis
Etiology
Cushing's Syndrome
Imaging
Hypothyroidism
Hyperthyroidism
Hypogonadism
Hypopituitarism
Acromegaly
Osteogenesis Imperfecta
Scurvy
Imaging
Protein Deficiency
Heparin Toxicity
Renal Osteodystrophy
Imaging Features
Arthropathies (Rheumatoid Arthritis)
Disuse Osteoporosis
Osteomalacia
Hyperparathyroidism
Diffuse Infiltrative Disorders
6.75 SOLITARY DENSE VERTEBRA
Lymph
Metastasis
Paget's Disease
Lymphoma
Hemangioma (Figs 6.77A and B)
6.76 ACRO-OSTEOLYSIS
Cleidocranial Dysostosis
Clavicles
Other Skeletal Abnormalities
Hajdu-Cheney Syndrome
Progeria
Findings
Pyknodysostosis
Features
Psoriatic Arthritis
Types
Findings
Sarcoidosis
Scleroderma/Progressive Systemic Sclerosis (PSS)
Distal Esophageal Stricture
Reiter's Syndrome
Miscellaneous syndromes
Symptoms and Signs
Cranio-mandibular Dysostosis
6.77 SACROILIITIS
Differential Diagnosis of Sacroiliitis
Reiter's Syndrome
Infection
ARTHRITIS INVOLVING SPINAL COLUMN
ANKYLOSING SPONDYLITIS (FIGS 6.80A AND B)
Spinal Column
Vertebral Body Squaring
Enthesitis
Spinal Fusion
Psoriatic Arthropathy
Clinical Features
Other Features
Reiter's Syndrome
RHEUMATOID ARTHRITIS (RA) (FIG. 6.81)
OSTEOARTHRITIS (OA) (DEGENERATIVE CHANGES)
DISH (FORESTIER'S DISEASE)
Enteropathic Spondyloarthropathies
Juvenile Rheumatoid Arthritis (JRA)
6.78 BONE CYST
NON-EXPANSILE UNILOCULAR CYSTIC LESIONS
NON-EXPANSILE MULTILOCULAR CYSTIC LESION
EXPANSILE UNILOCULAR CYSTIC LESIONS
Lesions Surrounded by Marked Sclerosis
Multiple Cystic Lesions
Fibrous Cortical Defect
Non-ossifying Fibroma
Simple Bone Cyst
Brown Tumor of HPT
Eosinophilic Granuloma
Enchondroma (Fig. 6.83)
Epidermoid Inclusion Cyst
Geodes
Intra-osseous Ganglion
Histiocytoma
Fibrous Dysplasia (Fig. 6.84)
Brodie's Abscess
Aneurysmal Bone Cyst (Fig. 6.85)
Osteoclastoma
Chondromyxoid Fibroma
Chondroblastoma
Plasmacytoma
Multiple Myeloma
Metastasis
CHAPTER 7:
Urogenital System
7.1 ADULT AND NEONATAL KIDNEY—DIFFERENCE
7.2 SMOOTH, SMALL KIDNEYS
SMALL, SMOOTH, UNILATERAL KIDNEY
A. Ischemia Due to Renal Artery Stenosis
Primary Uroradiologic Elements
CONTOUR–SMOOTH (GLOBAL)
Secondary Uroradiologic Elements
B. Chronic Renal Infarction
Primary Uroradiologic Elements
Secondary Uroradiologic Elements
C. Radiation Nephritis
Primary Uroradiologic Elements
Secondary Uroradiologic Elements
D. End Result of Renal Infarction
E. With Five or Less Calyces
SMALL, SMOOTH, BILATERAL KIDNEYS
7.3 SMALL SMOOTH KIDNEYS
Smooth
Small
1. Congenital
2. Postobstructive
3. Radiation Nephritis
4. End Result of Infarction
5. Renal Artery Stenosis
6. Generalized Arteriosclerosis and Arterial Hypotension
7. Chronic Glomerulonephritis
Chronic Papillary Necrosis
SMALL SMOOTH KIDNEY
Dilated PCS (Fig. 7.2)
Hypovolemic PCS
Hypoplastic PCS
B/L
Systemic
Renal
7.4 SMALL, IRREGULAR KIDNEYS
Chronic Pyelonephritis/Reflux Nephropathy
Primary Uroradiologic Elements
Secondary Uroradiologic Elements
Lobar Infarction
Primary Uroradiologic Elements
Secondary Uroradiologic Elements
Tuberculosis
Renal Dysplasia
7.5 LARGE SMOOTH KIDNEY
Unilateral
Renal Vein Thrombosis
Adults
Primary Uroradiological Elements
Secondary Uroradiologic Elements
ACUTE ARTERIAL INFARCTION
OBSTRUCTIVE UROPATHY
IVU—Features of Acute Obstruction
Features of Chronic Obstruction
Renal Size
Limitation
ACUTE PYELONEPHRITIS
XANTHOGRANULOMATOUS PYELONEPHRITIS
Radiological Features
COMPENSATORY HYPERTROPHY
Radiological Features
7.6 BILATERAL LARGE SMOOTH KIDNEYS
PROLIFERATIVE/NECROTIZING DISORDERS
Radiological Features
Amyloidosis
Radiological Features
MULTIPLE MYELOMA
Amyloidosis
Radiological Features
Other Radiological Features
Extraskeletal Features
ACUTE TUBULAR NECROSIS
Radiological Features
Collecting System
ACUTE CORTICAL NECROSIS
Radiological Features
Causes
LEUKEMIA
Radiological Features
ACUTE INTERSTITIAL NEPHRITIS
Clinical Features
Radiological Features
AUTOSOMAL RECESSIVE (AR) (INFANTILE) PCKD (POLYCYSTIC KIDNEY DISEASE)
Radiological Features
Juvenile Form
ACUTE URATE NEPHROPATHY
Radiological Features
NEPHROMEGALY ASSOCIATED WITH CIRRHOSIS, HYPERALIMENTATION AND DIABETES MELLITUS
7.7: NON-VISUALIZATION OF A KIDNEY DURING EXCRETION UROGRAPHY
Salient Feature
Associated Anomalies
PYONEPHROSIS
Tuberculosis
Renal Artery Stenosis
Spectral Analysis of Intrarenal Arteries
Renal Vein Thrombosis
Multicystic Kidney
Renal Tumors
Wilms' Tumor
Calcification
Renal Cell Carcinoma
7.8 DILATED CALYX AND DILATED URETER
With a Narrow Infundibulum
With a Wide Infundibulum
DILATED URETER AND CALYCES
Vesicoureteric Reflux
DILATED CALYX
Stricture
Extrinsic Impression by an Artery
Congenital Hydrocalycosis
Postobstructive Atrophy
Calculus
Blood Clot
Sloughed Papilla
PUJ Obstruction
Tumors
Tuberculous Stricture
Schistosomiasis
Ureterocele (Congenital)
Primary Megaureter
Retroperitoneal Fibrosis
Retrocaval Ureter
Vesicoureteric Reflux
Postpartum
7.9 GAS IN URINARY TRACT
A. Gas Inside the Bladder
Gas in Bladder Wall
Gas in Kidneys and Ureters
Gas inside the Bladder
B. In Bladder Wall
Emphysematous Cystitis
Intraluminal air-fluid level may be +
C. Gas in Kidneys and Ureters
Ureteric Diversion into the Colon
7.10 LOSS OF RENAL OUTLINE ON PLAIN FILM
Technical Factors
Congenital Absence of Kidney
Postnephrectomy
Ectopic Kidney
Perinephric Hematoma
Perirenal Abscess
Renal Tumor
7.11 RENOVASCULAR HYPERTENSION
Signs of Unilateral RAS on IVU
Signs of RAS on ACE Inhibitor Renal Scintigraphy
Signs of Renal Artery Stenosis on Doppler Sonography
Sign on Arteriography
CT Angiography
PC MRA
Causes
Atherosclerosis
Fibromuscular Dysplasia
Takayasu's Arteritis
Polyarteritis Nodosa
Neurofibromatosis
7.12 RENAL CALCIFICATION
A. Calculi
B. Dystrophic Calcification (Usually one kidney or part of one kidney)
C. Parenchymal Calcification
Medullary Nephrocalcinosis (Pyramidal)
Cortical Nephrocalcinosis
7.13 RENAL MASS
Cystic
Children (Pediatric)
Renal Cell Carcinoma
Primary Uroradiologic Elements
Secondary Collecting System
Primary Uroradiological Elements
Secondary Uroradiological Elements
Transitional Cell Carcinoma
IVP
USG
CT
Metastasis
Angiomyolipoma (AML)
Typical Findings
Primary
Oncocytoma
Sporadic Aniridia
Congenital Mesoblastic Nephroma
Primary
Multilocular Cystic Nephroma
Nephroblastomatosis
Simple Cysts/Localized Cystic Disease
SIMPLE CYST TYPICAL FINDINGS
Primary
Secondary
Primary
Secondary
Acquired Cystic Kidney Disease
Acute Focal Bacterial Pyelonephritis and Renal Abscess
ABSCESS TYPICAL IMAGING FEATURES
Primary
Secondary
7.14 CYSTIC DISEASE OF KIDNEYS
Cystic Neoplasams
GENETIC CONDITIONS
Autosomal Dominant
Autosomal Recessive
Cysts Associated with Syndromes
CLASSIFICATION OF RENAL CYSTS
Renal Dysplasia
Polycystic Disease
Cortical Cysts
Medullary Cysts
Miscellaneous
Neoplastic
Traumatic
Extraparenchymal Renal Cysts
Simple Cysts
Atypical Findings in a Cyst
DDx
CT Criteria
MRI Criteria
ATYPICAL CYSTS
Cystic RCC May Rarely Show Similar CT Features
POLYCYSTIC KIDNEY DISEASE
Autosomal Recessive Polycystic Kidney Disease (ARPKD—1980-81)
Autosomal Dominant Polycystic Kidney Disease (ADPKD)
Unilateral (Localized) Renal Cystic Disease (URCD)
Acquired Cystic Kidney Disease (ACKD)
EXTRAPARENCHYMAL RENAL CYSTS
DDx
Perinephric Cyst
Multilocular Cystic Nephroma
Multicystic Dysplastic Kidney (MDK)
Medullary Cysts
7.15 CARCINOMA OF THE BLADDER
Differential Diagnosis
Primary
7.16 BLADDER OUTFLOW OBSTRUCTION
BPH (Benign Prostatic Hyperplasia)
Carcinoma of the Prostate
Congenital Urethral Valves
Posturethral Valves
Urethral Atresia
Urethral Dysplasia
Anterior Urethral Diverticulum
Urethral Stricture
Traumatic Stricture
Urethral Calculus (Fig. 7.10)
Acquired Bladder Neck Stricture
Bladder Calculi (Fig. 7.11)
Fungal Ball
Bladder Tumors
Rhabdomyosarcoma
Radiological Features
Bladder—Sphincter Dys-synergia
Diagnosis Established by Videocystometrography (VCMG)
Neuropathic Lesions of Bladder
Complication
Prune-Belly Syndrome
Ectopic Ureterocele
Radiological Features
7.17 TESTICULAR TUMORS
DD of Testicular Tumors
Germ Cell Tumors (95%)
Stromal Tumors (3–5%)
Spread of Testicular Tumors
Lymphomas
Leukemia
Other Metastases
Cyst of Tunica Albuginea
INTRATESTICULAR CYST
Tubular Ectasia of Rete Testes
Cystic Dysplasia
Epidermoid Cyst
Abscess
7.18 SEMINAL VESICLE CALCIFICATION
Methods of Investigation
Differential Diagnosis
7.19 DIFFERENTIAL DIAGNOSIS OF ABNORMAL NEPHROGRAMS
7.20 FILLING DEFECT IN THE BLADDER
7.21 CARCINOMA PROSTATE
Anatomy
Premalignant Changes
Categories
Staging
DIAGNOSTIC WORK-UP
PROSTATE IMAGING
Ultrasound
CT SCAN
MRI
Treatment
Conclusion
7.22 THE PROSTATE
Normal Anatomy
Prostatic Anatomy (Fig. 7.12)
Sonographic Anatomy
Peripheral Zone
Transition Zone
Central Zone
Periurethral Glands
Adjacent Structures
CT Anatomy
MR Anatomy
PROSTATIC LESIONS
Agenesis/Hypoplasia
Congenital
Acquired
Infection of Prostate
Prostatic Calculi
Tumors of prostate
PROSTATIC AGENESIS/HYPOPLASIA
PROSTATE AND SEMINAL VESICLE CYSTS
Prostatic Cyst
Prostatic Utricle Cyst
Müllerian Duct Cyst
Ejaculatory Cyst
Retention Cyst
PROSTATIC INFECTIONS
Acute Prostatitis
Chronic Prostatitis
Prostatic Abscess
Granulomatous Prostatitis
Non-specific
Specific (Tubercular)
PROSTATIC CALCULI
BENIGN PROSTATIC HYPERPLASIA
Carcinoma Prostate
7.23 D/D OF ADRENAL MASS
CT Features S/O Adrenal Mass
Structures Mimicking Left Adrenal Mass
Salient Features
Medullary Tumors
Granulomas
Adrenal Cysts
Adrenal Hemorrhage
7.24 PAINLESS HEMATURIA
Definition
Etiology
Clinical Features
Pathology
Hematuria
Radiological Evaluation
Plain X-ray
Intravenous Pyelography
Barium Examinations
USG +/− CD
CT Scan
MRI
Renal Scan
Arteriovenography
Newer Modalities
RGU/MCU
Conclusion
CHAPTER 8:
Head, Neck and Spine
8.1 LUCENCY IN THE SKULL VAULT—WITHOUT SCLEROSIS
Idiopathic—Osteoporosis Circumscripta
Multiple Myeloma
RF
Hemangioma
Neurofibroma
Hyperparathyroidism
Traumatic
Langerhans' Cell Histiocytosis
Eosinophilic Granuloma
Metastasis—In Adults
8.2 LUCENCY IN THE SKULL VAULT— WITH SURROUNDING SCLEROSIS (FLOW CHART 8.1)
Developmental
Mucocele of Frontal Sinus
8.3 THICKENING OF THE SKULL VAULT
Generalized
Localized
Generalized Hyperostosis
Localized Hyperostosis of the Skull
8.4 GENERALIZED INCREASE IN DENSITY OF SKULL VAULT
Pyknodysostosis
Wormian Bones
Other Features
METABOLIC
Renal Osteodystrophy
Other Features
Fluorosis
Other Features
Acromegaly
8.5 LOCALIZED INCREASE IN DENSITY OF THE SKULL VAULT
In Bone
Chronic Subdural Hematoma
Basal Ganglia Calcification
Button Sequestra
8.6 DESTRUCTION OF PETROUS BONE (APEX)
Acoustic Neuroma
8.7 BASILAR INVAGINATION
Osteogenesis Imperfecta
Four Types
Platybasia
Causes
8.8 HAIR ON END SKULL VAULT
Hemolytic Anemia
Other Features
Thalassemia
Other Features
Neoplastic
Cyanotic Heart Disease
8.9 MULTIPLE WORMIAN BONES
Cleidocranial Dysplasia—AD
Hypothyroidism
Hypophosphatasia
8.10 POSTERIOR FOSSA CYSTS AND CYSTS-LIKE MASSES
Dandy-Walker Malformation
Associated Features
Mega Cisterna Magna
Posterior Fossa Arachnoid Cyst
Enterogenous Cyst
Inflammatory
Dermoid and Epidermoid
Cystic Neoplasm
8.11 ENLARGED SYLVIAN FISSURE/ MIDLINE CRANIAL FOSSA OF CSF DENSITY
8.12 SKULL BASE AND CAVERNOUS SINUS (FLOW CHART 8.2)
8.13 CENTRAL SKULL BASE LESIONS
8.14 CEREBELLO PONTINE ANGLE MASSES
8.15 SUPRASELLAR MASS (FIG. 8.6)
Intrasellar Lesions (Pituitary)
Infundibular Lesions
Suprasellar Lesions
Anterior 3rd Ventricle/Optic Chiasmatic Lesions
Sphenoid Sinus/Cavernous Sinus Lesions
Common Masses
Uncommon
Meningioma
Craniopharyngioma
Hypothalamoneurohypophyseal Axis Germinoma
Epidermoid Tumor
Dermoid Tumor
Vascular Lesion
Congenital
8.16 SELLAR AND SUPRASELLAR MASSES
Pituitary Adenoma
Classification
Plain X-ray (Fig.8.8)
Macroadenoma
Microadenoma
CT
MRI
PITUITARY APOPLEXY
CT
MRI
Empty sella
Classification
X-ray
CT (Empty Sella)
Craniopharyngioma
X-rays
CT
MRI (Craniopharyngioma)
Suprasellar Meningioma
X-ray
CT
MRI
ANEURYSM
X-ray
CT
MRI
RATHKE'S CLEFT CYST
CT
MRI
ARACHNOID CYST
CT
EPIDERMOID AND DERMOID
CT
MRI
TERATOMA
X-ray
CT
GERMINOMA (ATYPICAL TERATOMA)
CT
MRI
Visual Pathway Glioma (VPG)
CT
Chordoma
CT
MRI
Metastasis
Imaging
NEUROSURGEON'S QUERIES
8.17 EXPANDED PITUITARY FOSSA (FIG. 8.7)
Causes
Posterior Fossa Neoplasm in Childhood
Cerebellar Astrocytoma
Imaging
Ependymoma
8.18 RING ENHANCING LESIONS ON CECT
8.19 SUPERIOR ORBITAL FISSURE ENLARGEMENT
Causes
Bare Orbit Sign
Dermoid/Teratoma
Congenital Cystic Eye
AVM/CCF
NEOPLASM
Orbital Tumors
Capillary Hemangioma
Lymphoma
Meningioma
Nasopharyngeal Angiofibroma—Benign Tumor
Metastasis
Direct Encroachment
8.20 TEMPORAL BONE SCLEROSIS
D/D Temporal Bone Sclerosis
Pathology
Cochlear
Fibrous Dysplasia
Paget's Disease
Osteogenesis Imperfecta (van der Hoeve's Syndrome)
Osteopetrosis
Progressive Diaphyseal Dysplasia
Endosteal Hyperostosis
Van Buchem's Disease: Autosomal Recessive
Metastasis
Chronic Mastoiditis and CSOM (Fig. 8.9)
8.21 IV DISC SPACE CALCIFICATION
8.22 IVORY VERTEBRAL BODY
Single or Multiple Very Dense Vertebrae
8.23 ATLANTOAXIAL SUBLUXATION
Causes
8.24 POSTERIOR SCALLOPING OF VERTEBRAL BODY (FIG. 8.10)
8.25 ANTERIOR SCALLOPING OF VERTEBRAL BODIES (FIG. 8.12)
8.26 ANTERIOR VERTEBRAL BODY BEAKS
Achondroplasia
Down's Syndrome
8.27 BLOCK VERTEBRA (FIG. 8.13)
8.28 ENLARGED VERTEBRAL BODY
Generalized
Local—Single or Multiple
ABC
GCT
Hydatid
8.29 SOLITARY COLLAPSED VERTEBRA
D/D
Langerhans' Cell Histiocytosis
Benign
Hemangioma
Malignant Lesion
Metastasis
Multiple Myeloma/Plasmacytoma
8.30 MULTIPLE COLLAPSED VERTEBRAE
Osteoporosis
Neoplastic Disease
Trauma
Infection
Infection
Langerhans' Cell Histiocytosis
Sickle Cell Anemia
8.31 INTRASPINAL MASSES
I. Extradural Masses
II. Intradural Extramedullary Masses
III. Intramedullary Masses
8.32 DIFFERENTIAL DIAGNOSIS OF POSTERIOR FOSSA CYSTS
8.33 ENLARGED OPTIC FORAMEN
Concentric Enlargement
Local Defect
Roof
Medial Wall
Optic Nerve Glioma
Optic Nerve Sheath Meningioma
NF-1 (Neurofibromatosis-1)
Retinoblastoma
AV Malformation
Orbital Pseudotumor
Sarcoidosis
8.34 BARE ORBIT/HYPOPLASIA OF GREATER WING OF SPHENOID (FIG. 8.19)
Causes
Meningioma
Optic Glioma
Retinoblastoma
Neurofibromatosis
Eosinophilic Granuloma
Metastasis
Aneurysm
8.35 ORBITAL HYPEROSTOSIS
Causes
Meningioma (Optic Nerve)
Plain Film
Paget's Disease
Osteopetrosis
Lacrimal Gland Malignancy
Langer Cell Histiocytosis
Hyperostosis Frontalis Interna
8.36 CEPHALOCELES
Occipital and Parietal Cephaloceles (Fig. 8.20)
Sincipital and Sphenopharyngeal Cephaloceles
NASAL CEPHALOCELES, DERMOIDS AND GLIOMAS
ATRETIC CEPHALOCELES/MENINGOCELE
8.37 PATHOLOGICAL INTRACRANIAL CALCIFICATION
Tumors
Gliomas
Craniopharyngiomas
Meningiomas
Dermoids
Epidermoids
Teratomas
Pineal Tumors
Ependymomas
Choroid Plexus Papilloma
Lipoma
Chordomas
VASCULAR LESIONS
Aneurysms
Angioma
Chronic SDH
Intracerebral Hematoma
Atheromas
Infections and Infestations
Tuberculoma
Toxoplasmosis
CMV
Cysticercosis
Paragonimus Westermani
Metabolic and Miscellaneous
Basal Ganglia Calcification
Hyperparathyroidism
Neurofibromatosis
Tuberous Sclerosis
Sturge-Weber Syndrome
Lissencephaly
8.38 J-SHAPED SELLA (FIG. 8.22)
Common
Less Common
Optic Nerve Glioma
Hurler's Syndrome
Hydrocephalus
Hypothyroidism (Cretinism)
Achondroplasia (Autosomal Dominant)
Neurofibromatosis
Arachnoid Cyst (Leptomeningeal Cyst)
Findings on Skull X-ray
8.39 CEREBELLAR MALFORMATIONS
Differential Diagnosis
Chiari IV Malformations
Joubert's Syndrome
Rhombencephalosynapsis
Tectocerebellar Dysraphia
Miscellaneous
Dandy-Walker Complex
Dandy-Walker Variant
8.40 DEMYELINATING DISORDERS
Demyelination
Radiation and Chemotherapy
Dysmyelination
Paroxysmal Peroxisomal Disorders
Amino Acid Metabolism
Mitochondrial Dysfunction
Unknown
DEMYELINATION
Imaging
Acute Disseminated Encephalomyelitis
INFECTIOUS
Congenital and Perinatal Viral Infections
CMV
Herpes Simplex Encephalitis (HSE)
HIV ENCEPHALOPATHY
Marchiafava-Bignami Disease
Vascular Lesions
Subcortical Arteriosclerotic Encephalopathy: (Binswanger's Disease)
DYSMYELINATION (LEUKODYSTROPHIES)
Metachromatic Leukodystrophy
Krabbe's Disease (Globoid Cell Leukodystrophy)
Adrenoleukodystrophy
CT
MR
AMN
MELAS SYNDROME
MERRF SYNDROME
LEUKODYSTROPHIES—DISTINCTIVE FEATURES
8.41 PREVERTEBRAL SOFT TISSUE THICKENING
Fascial Spaces in Prevertebral Region
Causes of Prevertebral Soft Tissue (Cervical Region)
Retropharyngeal Lymph Adenopathy
Retropharyngeal Cellulitis and Abscess
Retropharyngeal Edema
Hemangioma
On CT and MRI
Lipoma
Tortuous Carotid Artery
Extension of Thyroid Masses
Prevertebral Abscess
Tumors
8.42 NASOPHARYNGEAL MASSES
Methods of Investigations
Computed Tomography
Magnetic Resonance Imaging
Differential Diagnosis of Nasopharyngeal Masses
Meningoceles
Adenoid Hyperplasia
Antrochoanal Polyp
Infections
Juvenile Angiofibroma
Chordomas
Carcinomas
Lymphomas
Extension from Nearby Structures
8.43 LARYNGEAL MASSES
Causes
Malignant Lesions
Benign Lesions
8.44 ORBITAL MASSES
Pediatric Orbital Tumors
Cystic Lesions
Dermoid Cysts
Teratomas
Vasculogenic Lesions
Capillary Hemangioma
Lymphangiomas
Orbital Meningiomas and Schwannomas
CAVERNOUS HEMANGIOMA (ENCAPSULATED VENOUS MALFORMATION)
METASTATIC TUMORS
MISCELLANEOUS
Rhabdomyosarcoma
Optic Nerve Gliomas
Fibrous Dysplasia
Metastatic Tumors
Adult Orbital Tumors
Paranasal Sinus Masses
Neoplasms of the Paranasal Sinuses
ORBITAL PSEUDOTUMOR (IDIOPATHIC ORBITAL INFLAMMATION)
Lacrimal Gland Tumors
Lymphoid Tumors
8.45 OCULAR MASSES
INTRAORBITAL CALCIFICATION
Causes
Classified as
Orbital Meningioma
Optic Nerve Meningioma
Hemangioma
Capillary Hemangioma
Cavernous Hemangioma
Orbital Varices
Rhabdomyosarcoma
8.46 INNER EAR MASSES
METHODS OF IMAGING
Masses
Neoplastic
Miscellaneous
Salient Features
Inflammatory
Intralabyrinthine Bleed
Vestibular Aqueduct Syndrome
Schwannoma
8.47 MIDDLE EAR MASSES (TABLE 8.2)
Congenital
Inflammatory
Neoplastic
Benign Tumor
Malignant Tumor
8.48 EXTERNAL ACOUSTIC MASSES
Causes
Keratosis Obturans
EAC Cholesteatoma (0.1 to 0.5% in EAC)
Malignant External Otitis
Exostosis
Osteomas
Squamous Cell Carcinoma
Ceruminomas
Metastasis
Epidermoidomas (Primary Congenital Cholesteatoma)
Histiocytosis
8.49 INTRAMEDULLARY LESIONS (FIG. 8.26)
Ependymoma
Intramedullary
Astrocytomas
X-ray
Myelography
Hemangioblastoma
C/F
Oligodendroglioma
Lipoma
Epidermoid
Syringohydromyelia
Hematomyelia
Intramedullary Abscesses
Infarction
8.50 INTRADURAL EXTRAMEDULLARY MASSES (FIG. 8.27)
Nerve Sheath Tumors
Meningiomas
Embryonal Tumors
Paragangliomas
Arachnoid Cysts
Metastases
Cysticercosis
Lateral Thoracic Meningoceles
Spinal Subdural Empyema
8.51 EXTRADURAL EXTRAMEDULLARY LESION (FIG. 8.28)
Epidural Space
D/Ds
Disk Bulge
X-ray
NECT/MR
Epidural Abscess
Epidural Hematoma
Hemangioma
C/F
Epidural Lipomatosis
Spinal Angiolipoma
Cysts
Malignant Lesions
Lymphoma—NHL → 85%
8.52 D/D OF FLOATING TOOTH
Definition
Causes
Salient Features
8.53 CYSTS OF JAW
Odontogenic Keratocyst
Dentigerous Cyst
Radicular (Apical) Cyst
Medial Mandibular
Medial Maxillary
Nasopalatine
Globulomaxillary
Simple Bone Cyst
Aneurysmal Bone Cyst
Differential Diagnosis
Location
Cystic Lesions of the Jaw
Postinflammatory
8.54 LOSS OF LAMINA DURA OF TEETH
Osteoporosis
Hyperparathyroidism
Cushing's Syndrome or Hypercortisolism
Osteomalacia
Paget's Disease
Scleroderma
Burkitt's Lymphoma
Langerhan's Sun Ray Histiocytosis
Infection
Neoplasms
Leukemia
Multiple Myeloma
Metastases
8.55 OPAQUE MAXILLARY ANTRUM
Sinusitis
Cysts in Antrum
Neoplasms
Wegener's Granulomatosis
Fibrous Dysplasia
8.56 THYROID LESIONS
Increased Uptake of Radiotracer
Grave's Disease
Toxic Multinodular Goiter
Hashimoto's Thyroiditis
Increased TSH Levels
Toxic Solitary Nodule
Hot Thyroid Nodule
Causes
Discordant Nodules
Cystic Lesions of Thyroid
Degeneration of Adenomatous Nodules
Cystic Papillary Carcinoma
Thyroid Abscess
Cold Nodules
Lymphoma
Metastasis
DECREASED OR NO UPTAKE OF RADIOTRACER
Solid Thyroid Nodule
Adenomatous Hyperplasia
Adenoma
Hürthle Cell Tumors
Thyroid Calcifications
CHAPTER 9:
Obstetrics and Gynecology
9.1 D/D BETWEEN BLIGHTED OVUM AND PSEUDOGESTATION OF ECTOPIC PREGNANCY
9.2 D/D BETWEEN ECTOPIC PREGNANCY, ABORTION IN PROGRESS (EARLY GESTATION) NABOTHIAN CYSTS
9.3 D/D BETWEEN PARTIAL MOLE, IUFD WITH HYDROPIC PLACENTAL DEGENERATION, TWIN PREGNANCY (MOLE AND FETUS)
9.4 D/D BETWEEN PELVIC MASSES, EXTRUDED FETAL PARTS WITH UTERINE PERFORATION; (FIG. 9.2) ECTOPIC PREGNANCY (POSTPARTUM/INTERVENTION)
9.5 D/D OF A PRESACRAL FETAL MASS
Causes
9.6 FETAL NECK MASSES
Causes
9.7 D/D OF FETAL RENAL CYSTIC DISEASES
9.8 D/D OF VARIOUS FETAL ANTERIOR ABDOMINAL WALL DEFECTS
9.9 D/D BETWEEN RENAL CYSTS AND HYDRONEPHROSIS
9.10 D/D OF CYSTIC ADNEXAL MASSES
9.11 D/D OF BENIGN AND MALIGNANT OVARIAN MASSES
9.12 D/D OF CYSTIC ABDOMINAL MASSES
Normal Ovaries
Abnormal Ovaries
Tubo-ovarian Abscess
Functional Cysts
Massive Ovarian Edema
Endometrioma
Dermoid
Cystadenoma/Cystadenocarcinoma
9.13 D/D OF NON-GYNECOLOGICAL PELVIC MASSES
D/D of Postoperative Pelvic Mass
9.14 D/D OF NON-OVARIAN ADENEXAL MASS
9.15 D/D OF OVARIAN MASSES
Ovarian Masses are Classified Histologically
SALIENT FEATURES
A. Epithelial Tumors
On USG
On Color Doppler
On CT Scan
On MRI
B. Germ Cell Tumors
C. Stromal/Sex Cord Tumors
D. Metastasis
Features of Malignancy
9.16 SONOGRAPHIC CLASSIFICATION OF ADENEXAL MASSES
Simple Cyst
Always Benign
Solid Masses
Benign
Malignant
Nongynecological
Complex Cyst
Benign
Malignant
Nongynecological
MRI Classification of Adenexal Masses
9.17 ABSENT INTRAUTERINE PREGNANCY WITH POSITIVE PREGNANCY TEST
Causes
Salient Features
9.18 D/D OF THICKENED PLACENTA (FLOW CHART 9.3)
Causes
Salient Features
9.19 ULTRASOUND SIGNS OF CHROMOSOMAL ABNORMALITY (FLOW CHART 9.4)
Generalized Signs Which are Important Even if Isolated
Important Specific Signs
Trisomy 21
Trisomy 18
Trisomy 13
Triploidy
Turner's Syndrome
9.20 D/D OF ENLARGED UTERUS (FLOW CHART 9.5)
Causes
Salient Features
9.21 CYSTIC STRUCTURES IN FETAL ABDOMEN (FLOW CHART 9.6)
Causes
Salient Features
9.22 D/D OF FETAL HYDROPS (FLOW CHART 9.7)
Causes
Salient Features
9.23 D/D OF FETAL BRAIN AND HEAD ABNORMALITIES
Causes
Salient Features
9.24 D/D OF BRAIN AND HEAD ABNORMALITY
9.25 D/D OF THICKENED ENDOMETRIUM (FLOW CHART 9.8)
Causes
Salient Features
9.26 USG SIGNS IN ABORTIONS (TABLE 9.1)
Abortion
Induced
Spontaneous
Salient Features
9.27 D/D OF FETAL CAUSES OF ABNORMALITY IN LIQOR VOLUME
Causes
Salient Features
9.28 D/D GAS IN THE GENITAL TRACT (FLOW CHART 9.11)
Causes
Salient Features
9.29 D/D OF FETAL INTRA-ABDOMINAL CALCIFICATION (FLOW CHART 9.12)
Causes
Salient Features
9.30 D/D OF FETAL THORACIC ABNORMALITIES (FLOW CHART 9.13)
Causes
Salient Features
INDEX
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