Thoracic Radiology: The Requisites, Second Edition

434 Pages·2010·155.13 MB·English

by  Theresa C. McLoud MD

Thoracic Radiology
SERIES EDITOR James H. Thrall, MD
Radiologist-in-Chief
Department of Radiology
Massachusetts General Hospital
Juan M. Taveras Professor of Radiology
Harvard Medical School
Boston, Massachusetts
OTHER VOLUMES IN Breast Imaging
THE REQUISITES IN RADIOLOGY SERIES Cardiac Imaging
Emergency Radiology
Gastrointestinal Imaging
Genitourinary Radiology
Musculoskeletal Imaging
Neuroradiology
Nuclear Medicine
Pediatric Radiology
Ultrasound
Vascular & Interventional Radiology
The RequisiTes
Thoracic
Radiology
Second Edition
Theresa C. McLoud, MD
Professor of Radiology
Harvard Medical School
Associate Radiologist-in-Chief
Director of Education
Thoracic Radiologist
Massachusetts General Hospital
Boston, Massachusetts
Phillip M. Boiselle, MD
Associate Professor of Radiology
Harvard Medical School
Associate Radiologist-in-Chief of Administrative Affairs
Director, Thoracic Imaging Section
Beth Israel Deaconess Medical Center
Boston, Massachusetts
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
Thoracic Radiology : The Requisites ISBN: 9780323027908
Copyright © 2010, 1998 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by
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Notice
Knowledge and best practice in this field are constantly changing. As new research and experience
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The Publisher
Library of Congress Cataloging-in-Publication Data
McLoud, Theresa C.
Thoracic radiology : the requisites / Theresa McLoud, Phillip Boiselle. – 2nd ed.
p. ; cm.–(Requisites series)
ISBN 978-0-323-02790-8
1. Chest–Imaging. I. Boiselle, Phillip M. II. Title. III. Series: Requisites series.
[DNLM: 1. Thoracic Diseases–radiography. 2. Lung Diseases–radiography. 3. Radiography,
Thoracic–methods. WF 975 M478t 2010]
RC941.M356 2010
617.5’407572–dc22
Acquisitions Editor: Rebecca Gaertner
Developmental Editor: Stacey Fisher
Publishing Services Manager: Hemamalini Rajendrababu
Project Manager: K. Anand Kumar
Design Direction: Steven Stave
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedication
“To my nephews, Malcolm and Paul”
TCM
“To my wife, Ellen”
PMB

List of Contributors
Suzanne Aquino, MD Conrad Wittram, MD
Radiologist Radiologist
Night Hawk Radiology Services Night Hawk Radiology Services
U.S. Corporate Office U.S. Corporate Office
Scottsdale, AZ Scottsdale, AZ
Jo-Anne O. Shepard, MD Subba Digumarthy, MD
Director of Thoracic Imaging Assistant Radiologist
Radiologist Thoracic Imaging Division
Department of Radiology Massachusetts General Hospital
Massachusetts General Hospital Boston, MA
Boston, MA Instructor in Radiology
Professor of Radiology Harvard Medical School
Harvard Medical School Boston, MA
Boston, MA
Stephen Ledbetter, MD, MPH
Beatrice Trotman-Dickenson, MD Director of Emergency Radiology
Thoracic Radiologist Brigham and Women’s Hospital
Brigham and Women’s Hospital Boston, MA
Boston, MA Assistant Professor of Radiology
Instructor in Radiology Harvard Medical School
Harvard Medical School Boston, MA
Boston, MA
vii
Acknowledgements
I am indebted to several individuals who have contrib- and the education in clinical decision-making that have
uted directly or indirectly to Thoracic Radiology: THE helped to make this book possible. It is only appropriate
REQUISITES. to recognize the outstanding mentors who have helped
First of all, Dr James H. Thrall, Radiologist-in-Chief at to foster and support my career as a thoracic radiologist.
Massachusetts General Hospital (MGH), Series Editor for Foremost is Dr Robert Fraser under whose tutelage I
THE REQUISITES, provided me with the encourage- trained and with whose textbook mine, of course, will
ment to see the second edition of this project through to never be able to compete. Dr Juan Taveras provided me
completion. This edition has been particularly enhanced with the opportunity to flourish as a junior staff mem-
by the contributions of Dr Phillip Boiselle from the Beth ber and eventually as a division head at MGH. Finally,
Israel Deaconess Medical Center and Harvard Medical I wish to acknowledge Dr Edward Gaensler, a thoracic
School in Boston, who is now a co-author of this textbook. surgeon, pulmonologist, and clinical researcher extraor-
A number of my present and previous colleagues at the dinaire, who helped to develop my interest in infiltrative
Department of Radiology at MGH have also contributed orig- and occupational lung disease.
inal chapters and/or revisions. I am indebted to Dr Jo-Anne Finally, this book could not have been possible with-
O. Shepard and Dr Subba Digumarthy, Dr Suzanne Aquino, out the dedication of many people involved in all stages
as well as Dr Beatrice Trotman-Dickenson and Dr Stephen of book preparation. Melanie Miller, Staff Assistant at
Ledbetter, currently radiologists at the Brigham and Women’s MGH, provided secretarial assistance with the revised
Hospital in Boston, Harvard Medical School. Together we manuscripts. I also wish to thank and recognize all the
have attempted to craft an up-to-date textbook that reflects professionals with whom I have worked at Elsevier. Their
not only a large body of factual material about thoracic dis- support and encouragement over the past few years have
eases, but that also offers our own approach to radiographic made this publication possible.
interpretation and diagnostic investigation.
I also wish to acknowledge all of my clinical colleagues T.C.M.
in pulmonary medicine, critical care, and thoracic surgery
who over the years have provided both the inspiration
xiii
Foreword
THE REQUISITES series is designed to provide core has also displaced radionuclide imaging in many settings
material in major subspecialty areas of radiology for use by for the diagnosis of pulmonary embolism which was not
residents and fellows during their training and by practicing nearly as important or well understood at the time of the
radiologists seeking to review or expand their knowledge. previous edition of Thoracic Radiology: THE REQUSITES.
These books have also been found of value by non imag- Since the first edition, positron emission tomography
ing specialists in their own respective areas of interest. (PET) and PET/CT have become extraordinarily impor-
Thoracic Radiology: THE REQUISITES has been a tant in the practice of thoracic radiology. New insights into
particularly popular book in the requisites series. Thoracic lung cancer have come from their application among other
imaging is part of the heart and soul of the specialty of radi- diseases. Magnetic resonance imaging has also begun to be
ology and encompasses a number of the most commonly applied more to diseases of the thorax although this modal-
performed procedures in our specialty. The subject is of ity still lags CT by a substantial margin. Dr McLoud and
interest to every radiologist. her co-authors have done a comprehensive job in including
Each book in the THE REQUSITES series presents these and many other new directions into their book.
special challenges in terms of its development. One of the In a real sense, those entering training in radiology have
challenges for thoracic radiology is that, taken together, a greater challenge than those entering many other disci-
imaging studies of the chest continue to represent the plines. A surgical or medical house officer might find him-
largest aggregate number of procedures performed in con- self or herself performing a physical examination during
temporary radiology practice. And, somehow, the “simple” their first days in their respective programs, something
chest x-ray is as complex and full of mystery as any of our they learned in medical school. However, in radiology the
more modern methods. Dr Theresa C. McLoud and her knowledge base from medical school is only preparatory to
contributors have done a magnificent job of distilling the the opportunity to begin learning radiology. Thus, THE
essential facts and concepts of thoracic radiology into a REQUISITES series is specifically designed to help radi-
text that will serve the resident and practicing radiologist ologists in training navigate from a very limited knowledge
equally well. of imaging to a sufficient knowledge to begin engaging in
As noted in the foreword to the first edition of Thoracic clinical practice in a short period of time.
Radiology: THE REQUISITES, each volume in the I believe residents in radiology will find Thoracic
series lends itself to a unique organizational structure. Radiology: THE REQUISITES to be an excellent tool
Dr McLoud is retaining the logical structure of the first for learning the subject. The book is comprehensively
volume. Technical and anatomical considerations are first updated and illustrated with the most recent applications.
presented followed by an exploration of the component In keeping with the philosophy of the series, the book can
parts of the chest including the lung, airways, pulmonary be reasonably read and reread during successive thoracic
vasculature, mediastinum and pleura. Each chapter further radiology rotations in a residency program. For practicing
subdivides the discussion by anatomy and disease category. physicians, Thoracic Radiology: THE REQUISITES should
This approach to organization maximizes the access by the be attractive as a concise and useful way to build or refresh
reader to desired information and makes using the book their knowledge of thoracic imaging.
extremely efficient for both an initial introduction and an I congratulate Dr Theresa C. McLoud and her contribu-
in depth review. tors for another outstanding edition of Thoracic Radiology:
Much of thoracic radiology is enduring but as with the THE REQUISITES.
rest of the specialty of radiology, there have been major
changes and advances in both our understanding of disease James H. Thrall, MD
and the technology that we apply to its diagnosis. Advances Radiologist-in-Chief
in CT from spiral scanning to progressively higher num- Department of Radiology
bers of rows for multi-slice CT devices have revolutionized Massachusetts General Hospital
the application of CT. New approaches have been neces- Juan M. Taveras Professor of Radiology
sary for many conditions ranging from follow-up of pulmo- Harvard Medical School
nary nodules to diagnosis of interstitial lung disease based Boston, Massachusetts
on the superior resolution of today’s imaging devices. CT
ix