Musculoskeletal Imaging: A Teaching File (LWW Teaching File Series)

1152 Pages·2012·17.647 MB·English

by  Felix Chew MD

Musculoskeletal
Imaging
ATeaching File
THIRD EDITION
Felix S. Chew, M.D., ED.M., M.B.A.
Professor of Radiology
Vice-Chair for Academic Innovation
Section Head of Musculoskeletal Radiology
University of Washington, Seattle, Washington
Hyojeong Mulcahy, M.D.
Assistant Professor of Radiology
University of Washington, Seattle, Washington
Alice S. Ha, M.S, M.D.
Assistant Professor of Radiology
University of Washington, Seattle, Washington
Senior Executive Editor: Jonathan Pine
Product Manager: Ryan Shaw
Vendor Manager: Alicia Jackson
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Copyright © 2012 Text and Illustrations by Felix S. Chew, M.D.
Copyright © 2012 Design and Publication Rights by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business
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LWW.com
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2 edition Copyright © 2006 Design and Publication Rights by LIPPINCOTT WILLIAMS & WILKINS
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1 edition Copyright © 2000 Design and Publication Rights by LIPPINCOTT WILLIAMS & WILKINS
All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including
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Printed in China
Library of Congress Cataloging-in-Publication Data
Chew, Felix S.
Musculoskeletal imaging : a teaching file / Felix S. Chew, Hyojeong Mulcahy, Alice S. Ha. —3rd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-60913-793-9
I. Mulcahy, Hyojeong. II. Ha, Alice S. III. Title.
[DNLM: 1. Musculoskeletal Diseases—radiography—Case Reports. 2. Diagnostic Imaging—Case Reports. WE 141]
LC classification not assigned
616.7'0754—dc23
2011030701
Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors,
editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and
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of the information in a particular situation remains the professional responsibility of the practitioner.
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PUBLISHER’S FOREWORD
Teaching Files are one of the hallmarks of education in radiology. There has long been a need for a
comprehensive series of books, using the Teaching File format that would provide the kind of personal
consultation with the experts normally found only in the setting of a teaching hospital. Lippincott Williams
& Wilkins is proud to have created such a series; our goal is to provide residents, fellows and practicing
radiologists with a useful resource that answers this need.
Actual cases have been culled from extensive teaching files in major medical centers. The
discussions presented mimic those performed on a daily basis between residents and faculty members in
all radiology departments.
The format of this series is designed so that each case can be studied as an unknown, if desired. A
consistent format is used to present each case. A brief clinical history is given, followed by several
images. Relevant findings, differential diagnosis, diagnosis, discussion of the case, figure legends and
references conclude each case. In this manner, the authors guide the reader through the interpretation of
each case, with a strong emphasis on critical thinking.
We hope that this series will become a valuable and trusted teaching tool for radiologists at any stage
of training or practice, and that it will also be a benefit to clinicians whose patients undergo these imaging
studies.
The Publisher
FOREWORD
The third time’s a charm!
The third edition of Musculoskeletal Imaging: A Teaching File is new and improved, updated and
authoritative, and, indeed, just what you need to upgrade your skills and maintain your competence in
musculoskeletal (MSK) imaging. Doctors Chew, Mulcahy, and Ha have maintained the same high-quality
standards in the selection and presentation of their material in the third edition as in past editions—no
small task.
Advances in MSK imaging have continued apace requiring that older, analogue film based images be
removed and replaced with digital images from newly acquired cases as well as necessitating the
addition of more timely cases with multidetector CT and MRI. All this has been done to good effect.
The remarkably concise format highlights the principal imaging and clinical characteristics of each
case. As in previous editions, every page or two contain a separate case with images; each of the eight
chapters contains up to 50 or more cases devoted to a single anatomic region of the skeleton. The cases
selected cover the entire spectrum of disease encountered: arthritis, trauma, infection, tumor, metabolic,
and congenital diseases. The pertinent imaging findings are discussed, a germane, realistic differential
diagnosis is presented, and each case is concluded with a brief review of the pertinent pathophysiology
and etiology of the disease.
Are you in need of a quick reference book in MSK imaging? Are you preparing to take the American
Board of Radiology examination? Would you like to have an easy way to refresh or periodically reassess
your skills in MSK imaging? Do you yearn for a simple, straightforward method of testing your
competence in MSK imaging? Then this is the book for you.
Exactly how you use the book is up to you. You could simply read it cover to cover and, as a result,
be infinitely more informed about MSK radiology. Or you could test yourself by reviewing the images and
coming up with an answer before reading the accompanying text to determine if you noted the important
findings and made the correct diagnosis. Or you could go at it until the wee hours of the morning as in
cramming for the board examination. Or you could look up cases as you encounter them in your practice to
substantiate your diagnoses or to make certain you include the most likely alternative diagnoses. The
choice is yours.
Have at it! Read, mark, and inwardly digest! Enjoy! Regardless of your specific needs in MSK
imaging, the fruits of Drs. Chew’s, Mulcahy’s, and Ha’s labors are certain to prove both refreshing and
informative.
Lee F. Rogers, M.D.
Tucson, Arizona
October 5, 2011
PREFACE
This book of teaching file cases is intended to duplicate the learning experience of sitting at the view-box
with an expert skeletal radiologist and master teacher. Unlike a comprehensive textbook organized
according to pathophysiology, this book is organized by anatomic regions. It provides a broad variety of
cases, each intended to teach the nuances of image-based diagnostic reasoning. The cases encompass all
imaging modalities, including radiography, CT, MR imaging, nuclear imaging, and sonography, as well as
all categories of disease, including trauma, tumors, joint disease, endocrine and metabolic bone disease,
infections, congenital and developmental conditions, and musculoskeletal manifestations of systemic
disease. The cases are presented as unknowns in a consistent format. Each begins with a brief clinical
history and one or more radiologic images. A description of the relevant findings, the diagnosis, and
comments regarding the case follow, with emphasis on image-based diagnostic reasoning. The
discussions reflect those that typically occur between radiologic consultant and clinician or between a
faculty member and radiology trainee. An extensive subject index and lists of diagnoses organized by
pathophysiology and anatomic region make the material accessible for use as a reference or as an atlas.
Case selection is not intended to parallel ones daily clinical experience at the workstation, nor to
provide an exhaustive subject review. Rather, the cases make specific teaching points, raise clinically
relevant issues, satisfy intellectual curiosity, and reflect the particular interests of the authors. By
including a number of companion cases, we hope to give the reader an appreciation of the range of
radiologic variety in specific diseases. Although the teaching file is organized by anatomic region, in
some cases of systemic or polyostotic disease, companion images from other regions are included for
convenience. Many diagnoses are represented by more than one case. Some discussions range well
beyond the analysis of imaging features and differential diagnosis to include the pathophysiology
underlying the images, as well as clinical and management considerations.
Felix S. Chew, M.D.
Hyojeong Mulcahy, M.D.
Alice S. Ha, M.D.
ACKNOWLEDGMENTS
Preparation of the first edition of Musculoskeletal Imaging: A Teaching File, was begun at
Massachusetts General Hospital (MGH), during the time that Susan G. Leffler, M.D., and I were members
of the Division of Bone and Joint Radiology. With the help of Catherine Maldjian, M.D., who was on the
faculty at Temple University at the time and subsequently at New York University Medical Center, the
book was completed while I was Section Head of Musculoskeletal Radiology at Wake Forest.
Contributions to the first edition were also made by Michael E. Mulligan, M.D., and Donald J. Flemming,
M.D. The preponderance of the case material for the first edition was drawn from MGH, and most of the
remaining material was drawn from the personal teaching collections of the authors. I acknowledge the
gracious help of my former MGH colleagues, Drs. Daniel I. Rosenthal, Susan V. Kattapuram, and William
E. Palmer, for providing me with or guiding me to interesting cases. Preparation of the second and third
editions was completed at the University of Washington. My coauthor for the second edition was
Catherine C. Roberts, M.D., of the Mayo Clinic in Scottsdale, AZ, with contributions from Anand P.
Lalaji, M.D. My former colleagues at Wake Forest University, Drs. Carol A. Boles, Leon Lenchik, and
Lee F. Rogers, brought many interesting cases to my attention. Some additional material was developed at
the University of Washington with the help of Michael L. Richardson, M.D. I also wish to thank the many
residents and fellows whose comments helped shape the final product.
Felix S. Chew, M.D.
CONTRIBUTORS TO THE FIRST EDITION
Felix S. Chew, M.D.
Seattle, Washington
Donald J. Flemming, M.D.
Hershey, Pennsylvania
Susan G. Leffler, M.D.
Richmond, Virginia
Catherine Maldjian, M.D.
West Caldwell, New Jersey
Michael E. Mulligan, M.D.
Baltimore, Maryland
CONTRIBUTORS TO THE SECOND EDITION
Felix S. Chew, M.D.
Seattle, Washington
Anand R Lalaji, M.D.
Toccoa, Georgia
Catherine C. Roberts, M.D.
Scottsdale, Arizona