DIAGNOSTIC RADIOLOGY CHEST AND CARDIOVASCULAR IMAGING
AIIMS–MAMC–PGI IMAGING COURSE SERIES
PAST EDITORS
DIAGNOSTIC RADIOLOGY CHEST AND CARDIOVASCULAR IMAGING
FOURTH EDITION
EDITORS
Anju Garg MD
Director Professor and Head Department of Radiodiagnosis Maulana Azad Medical Collage New Delhi, India
Niranjan Khandelwal MD Dip NBE FICR FAMS
Professor and Head Department of Radiodiagnosis and Imaging Postgraduate Institute of Medical Education and Research Chandigarh, India
Arun Kumar Gupta MD FAMS
Professor and Head Department of Radiodiagnosis All India Institute of Medical Sciences
New Delhi, India
ASSOCIATE EDITORS
Sanjiv Sharma MD
Professor and Head Department of Cardiovascular Radiology and Endovascular Interventions All India Institute of Medical Sciences
New Delhi, India
Rashmi Dixit MD
Director Professor Department of Radiodiagnosis Maulana Azad Medical College
New Delhi, India
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Diagnostic Radiology: Chest and Cardiovascular Imaging
First Edition: 1996
Second Edition: 2003
Third Edition: 2010
Fourth Edition: 2018
9789352703081
Printed at
- Akshay Kumar Saxena MD Dip NBE FICR
- Professor
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Alpana Manchanda MD
- Director Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Anjali Prakash DMRD DNB MNAMS
- Director Professor
- Department of Radiodiagnosis
- Maulana Azad Medical Collage
- New Delhi, India
- Anju Garg MD
- Director Professor and Head
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Ankur Goyal MD DNB MNAMS
- Assistant Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Anmol Bhatia MD
- Assistant Professor
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Anupam Lal MD
- Professor
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Arun Kumar Gupta MD FAMS
- Professor and Head
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Ashu Seith Bhalla MD MAMS FICR
- Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Atin Kumar MD DNB MNAMS FICR
- Professor
- Department of Radiodiagnosis (Trauma Center Division)
- All India Institute of Medical Sciences
- New Delhi, India
- Chandan J Das MD DNB MNAMS
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Deep N Srivastava MD MBA FAMS FICR
- Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Devasenathipathy Kandasamy MD DNB FRCR
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Gaurav Shankar Pradhan MBBS DMRD DNB
- Director Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Gurpreet Singh Gulati MD
- Professor
- Department of Cardiovascular Radiology and
- Endovascular Interventions
- All India Institute of Medical Sciences
- New Delhi, India
- Jyoti Kumar MD DNB MNAMS
- Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Kartik Ganga MD
- Fellow
- Department of Cardiovascular Radiology and
- Endovascular Interventions
- All India Institute of Medical Sciences
- New Delhi, India
- Kushaljit Singh Sodhi MD PhD MAMS FICR
- Professor
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Madhusudhan KS MD FRCR MAMS
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Mahesh Prakash MAMS FIACM FICR
- Professor
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Manavjit Singh Sandhu MD FICR
- Professor
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Mandeep Garg MD
- Additional Professor
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Mandeep Kang MD FICR MAMS
- Professor
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Manisha Jana MD DNB FRCR
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Manphool Singhal MD DNB MAMS FSCCT (USA)
- CMR-Fellowship (London)
- Associate Professor
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Mukesh Kumar Yadav MD
- Assistant Professor
- Department of Radiodiagnosis (BRA IRCH Division)
- All India Institute of Medical Sciences
- New Delhi, India
- Naveen Kalra MD FICR MAMS
- Professor
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Nidhi Prabhakar MD DNB
- Assistant Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Niranjan Khandelwal MD Dip NBE FICR FAMS
- Professor and Head
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Pankaj Gupta MD DNB
- Assistant Professor
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Priya Jagia MD DNB
- Department of Cardiovascular Radiology and
- Endovascular Interventions
- All India Institute of Medical Sciences
- New Delhi, India
- Priyanka Naranje MD DNB MNAMS
- Assistant Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Radhika Batra MD DNB
- Assistant Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Raju Sharma MD MAMS FICR
- Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Rashmi Dixit MD
- Director Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Sameer Vyas MD
- Associate Professor
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Sanjay Sharma MD DNB MNAMS FRCR FICRI
- Professor
- Department of Radiodiagnosis (RP Center Division)
- All India Institute of Medical Sciences
- New Delhi, India
- Sanjeev Kumar MD
- Assistant Professor
- Department of Cardiovascular Radiology and
- Endovascular Interventions
- All India Institute of Medical Sciences
- New Delhi, India
- Sanjiv Sharma MD
- Professor and Head
- Department of Cardiovascular Radiology and
- Endovascular Interventions
- All India Institute of Medical Sciences
- New Delhi, India
- Sapna Singh MD DNB MNAMS
- Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Shivanand Gamanagatti MD MNAMS
- Professor
- Department of Radiodiagnosis (Trauma Center Division)
- All India Institute of Medical Sciences
- New Delhi, India
- Smita Manchanda MD DNB
- Assistant Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Smriti Hari MD MAMS
- Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Surabhi Vyas MD DNB MNAMS
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Swati Gupta MD DNB FRCR
- Assistant Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi, India
- Ujjwal Gorsi MD
- Assistant Professor
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Uma Debi MD
- Assistant Professor
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Vivek Gupta MD DM (Neuroradiology)
- Assistant Professor
- Department of Radiodiagnosis and Imaging
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
The first edition of Diagnostic Radiology: Chest and Cardiovascular Imaging was published in 1996. Subsequently the second and third editions were printed in 2003 and 2010, respectively. These books became immensely popular among the postgraduate students. Seven years later this fully updated fourth edition is being published to reflect the changes that have taken place in this continually evolving field.
Imaging of chest and cardiovascular diseases constitutes a major segment of any radiology practice. While conventional radiography continues to be an important initial diagnostic tool, the skills for interpretation of the same are declining. The result is an increasing and at times unwarranted use of computed tomography. While CT has no doubt revolutionized the understanding of thoracic disease, MR too has quietly made inroads into chest imaging. Technical advances in CT and MR have resulted in several new and exciting applications in hitherto uncharted territories. The present-day radiologists need to be familiar with both, the age old and time tested plain radiograph and the latest in cross-sectional imaging, so that they can choose the most appropriate modality to answer the clinical question at hand.
We hope that this fourth 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 All India Institute of Medical Sciences (AIIMS), New Delhi; Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, and Maulana Azad Medical College (MAMC), New Delhi, for their contribution and active support without which this endeavor would not have been possible.
We would also like to thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Ms Chetna Malhotra Vohra (Associate Director–Content Strategy), Ms Sheetal Arora Kapoor (Senior Development Editor), for their professional help and cooperation in publishing this book in the present form.
Editors
Anju Garg
Arun Kumar Gupta
Niranjan Khandelwal
Associate Editors
Sanjiv Sharma
Rashmi Dixit
Preface to the First Edition
It is with great pleasure the faculty of Department of Radiodiagnosis at All India Institute of Medical Sciences, New Delhi; 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 Professor K Subbarao and Professor Ratni B Gujral, who have been kind enough to submit their contributions well in time.
Manorama Berry
Veena Chowdhury
Sudha Suri
Sima Mukhopadhyay