17
Radiologic Diagnosis of Chest Disease
Radiologic Diagnosis of Chest Disease
Springer London Berlin Heidelberg New York Barcelona Hong Kong Milan Paris Singapore Tokyo
Miriam Sperber (Ed.)
Second Edition
With 427 Figures
, Springer
Miriam Sperber, MD Department of Diagnostic Imaging, Vall d'Hebron Hospital, Universitat Autonoma, Barcelona, Spain
Cover illustrations: Insets show conventional chest radiography, MRI and CT, commonly employed in the diagnosis of chest diseases.
British Library Cataloguing in Publication Data Radiologic diagnosis of chest disease. - 2nd ed.
1. Chest - Imaging. 2. Chest - Diseases - Diagnosis 1. Sperber, Miriam 617.5'4'0757
Library of Congress Cataloguing-in-Publication Data Radiologic diagnosis of chest disease/Miriam Sperber (ed.) - 2nd ed.
p.;cm. Includes bibliographical references and index.
ISBN-13: 978-1-4471-1179-5 DOl: 10.1007/978-1-4471-0693-7
e-ISBN-13: 978-1-4471-0693-7
1. Chest - Imaging. 2. Chest - Radiography. 1. Sperber, Miriam. [DNLM: 1. Radiography, Thoracic. 2. Diagnostic Imaging. 3. Thorax - pathology.
4. Thorax - radionuclide imaging. 5. Thorax - ultrasonography. WF 975 R129 2001] RC941. R26 2001 617.5'40757 - dc21 00-038603
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers.
© Springer-Verlag London Limited 2001
Softcover reprint of the hardcover 2nd edition 2001
First published 1990 Second edition 2001
The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use.
Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature.
Typeset by EXPO Holdings, Malaysia
28/3830-543210 Printed on acid-free paper SPIN 10728391
This book is dedicated with love to my children: Dr. Steven Sperber, Dr. Galia Angela Sperber and
Alex Sperber, LLB.
Foreword
Prior to the virtual atomic explosion of medical knowledge, at a time when communication was very much slower, a medical book, to be authoritative and believable, had to be written by a very knowledgable, and, per force, usually quite senior person. The choice of texts was limited and tended to be dominated by a few "classic" (a phrase not quite synonymous with dogma). Following the information explosion, the scenario is quite different. Not only is there a geometric progression in the quantity and speed of development of new medical knowledge, but also this development is occurring at very different rates in different countries.
This is particularly true in medical imaging. The result is that it is now virtually impossible to produce a "single author" book that can cover the field or even a subdivision of it. This absolute requirement for multiple authors has in turn created the need for a new type of editor/author who must be multinational in approach, have a uniquely informed appreciation of what is going on in medical imaging research throughout the entire world and possess the depth of personal knowledge and experience to judge correctly what work is the most rigorous and likely to have the greatest impact. This "newwave" editor must further have the personality and kudos to be able to persuade the chosen few to add still further to their burdens by writing a book chapter!
This book epitomizes what can be achieved by just such an editor, Miriam Sperber, MD. The first edition of this book set a high standard in clarity and concise coverage and the new revised text ensures that even in this fast-moving information era, the book retains its leading position at the cutting edge of medical imaging in pulmonary medicine. Dr. Sperber's eminent team of authors has provided us with a mine of information and I believe that the reader will find that every chapter contains the rarely found gold of new knowledge.
Eric N.C. Milne, MD, FRCR, FRCP (Edin.)
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Preface
X-RAYS: Their moral is - that a right way of looking at things will see through almost anything.
Samuel Butler, Note-Books, Vol. V
It is always a thrilling experience to prepare a new edition of a textbook, and a daunting one as well. Firstly, there is the natural gratefulness for the gift of life and experience that allows a renewed revision and summary of collected knowledge in a specific area. Then, there is the exciting appreciation of wonderful advances in the studied domain. One worries whether the attempt to bring forward the inspiring progression will be successful, as well as accurately reflect the continuous search for additional answers to existent medical queries.
Thoracic radiology has proven itself to be a fitting component of a new, reinvented and vigorous diagnostic field. To paraphrase Newton, we look back with humility and admiration to the giants that preceded us, and while standing on their shoulders, have the possibility of seeing a bit further. Roentgen's initial vision, courage and determination have been undoubtedly replicated in the works of pioneers of the chest-imaging area, such as Leo Rigler, Felix Fleischner and Benjamin Felson. Their thinking power and dedication serve as an example for an endless line of radiologists working in this field. It is with great sadness that I have to mention here the untimely loss of one of their top representatives, a wonderful friend and supporter, Charles Putman, who was due to contribute a chapter to this volume, and whose professional excellence was matched by extraordinary human qualities. This Preface is dedicated to him.
Nowadays, when reviewing chest radiology, it has become imperative to discuss not only the new and improved diagnostic capabilities resulting from the utilization of advanced techniques, but also the impact that these technologies have on medical therapeutics in general. The high quality and extensive diagnostic details provided by new imaging modalities have ensured that, currently, thoracic radiology occupies a central place in the diagnostic process, as well as in the follow-up of a given patient.
Localization and extension of primary and secondary lesions, early signs and development of diffuse lung disorders, vascular and bony anomalies, and many other pathologic changes, are clearly and reliably identified, due to refinements occurring in recent years in the existent diagnostic techniques. Computed tomography has seen the development of spiral, high resolution and volumetric studies, while Magnetic resonance imaging strives to perfect the use of new imaging materials. Far from being forgotten, conventional radiology is under continuous scrutiny, as the desire exists to improve its capabilities in such vital areas as the intensive care unit or malignancy screening.
Our volume has the goal of faithfully depicting the above, while at the same time underlining the importance of the close cooperation necessary between diagnostic radiologists and their clinical counterparts. We are proud to have been able to include among our eminent authors representatives of both categories, which will certainly enhance the book's ability to correctly reflect the daily diagnostic dilemmas
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x Preface
of a medical and radiologic practice. It will also add to its capability of providing necessary and valuable information both to the young trainee and to the experienced specialist.
Moreover, the highly international character of our contributors is of paramount importance in the transmission of the global spirit of modern medical science, and thus will increase the value of the presented material, as a shared experience of experts from important medical centers all over the world.
Our book is being published, appropriately enough, at the dawn of a new millennium. Radiologic sciences can certainly be counted among the greatest discoveries of the last thousand years. It is therefore the time to look forward to many more scientific advancements, with the hope that, in the words of a great luminary of our time, Albert Einstein, "human benefit will remain our main concern, while technology will be a blessing, and not a curse to mankind".
Acknowledgments
Making an orchestra play in unison is never an easy task. My role in this case was immensely facilitated by the quality of the players. I am greatly indebted to all contributors to this volume for agreeing to share their experience and for their exceptional effort in providing material of the highest quality. It was a great pleasure and a privilege to cooperate with them all.
My thanks go also to my dear friends and colleagues, Dragutin Novak, MD, Eric N.C. Milne, MD, and Jose Caceres, MD, for their continuous support and encouragement.
My secretaries Nikki Edwards and Gloria Simpson dealt in a splendid manner with often complex organizational jobs.
Last, but not least, my love and thanks go to my family for providing a wonderful and vital foundation for my work. I couldn't do it without them.
Miriam Sperber, MD
Contents
List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. xv
Part 1 Anatomy
Normal Anatomy of the Human Lung and Associated Structures P. Gehr ................................................................ 3
Part 2 Imaging of the Human Chest
2 Clinical History and Physical Examination A. Simonds, S. Sperber, and S. W. Clarke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 31
3 Conventional Chest Radiography D. Westra and M. Sperber ................................................ 37
4 Computed Tomography of the Thorax: Lungs and Mediastinum M. Sperber ............................................................ 56
5 Magnetic Resonance Imaging of the Thorax M. Sperber ............................................................ 78
6 Ultrasound of the Chest J. Andreu, J. Caceres, and M. Lopez. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 92
7 Conventional and Digital Subtraction Angiography A. Magalhaes ......................................................... 102
8 Pulmonary Function Tests C. Straus, T. Similowski, f.-P. Derenne, and M. Zeiter . ....................... 116
9 Bronchoscopy and Surgical Procedures for Inspection and Biopsy M. Riquet and P. Reynaud . ............................................. 130
10 Bronchoalveolar and Serum Markers of Lung Disease N. Le Flour, S. fouveshomme, and f.-P. Derenne ............................ l36
11 Radionuclide Studies of the Lung N.D. Greyson ......................................................... 148
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xii Contents
Part 3 Diseases of the Lung and Related Structures
12 Abnormalities of Pulmonary and Mediastinal Vessels N. Vasile and M.e. Anglade ............................................. 161
13 Pneumonias P.L. Clouet, Y. Berthezene, B. Marchand, P. Nesme, and J.-F. Mornex ........... 171
14 Diagnostic Imaging of Pulmonary Tuberculosis T. Pirronti, R. Manfredi, and P. Marano . .................................. 180
15 Sarcoidosis J.P. Lynch III and E.A. Kazerooni 193
16 Chronic Obstructive Pulmonary Disease E.A. Kazerooni, K.R. Flaherty, and F.J. Martinez 221
17 Pulmonary Disease in the Immunocompromised Host N. W. Schluger and G. Pearson ........................................... 236
18 Radiology of Diffuse Lung Disease J. Collins ............................................................. 254
19 Cystic and Cavitary Lung Disorders K. Nishimura, S. Oguri, and H. Itoh ...................................... 267
20 Pulmonary Manifestations of Systemic Diseases B.H. Gross, K.A. Buckwalter, D.L. Spizarny, M. Rebner, and M. Sperber ........ 283
21 Pulmonary Abscess and Empyema G. Simonetti, G. Sergiacomi, A. Moscone, R. Cancellieri, and L. Mancini ....... .301
22 Pulmonary Atelectasis J. Nishi, S. Tomiguchi, and M. Takahashi ....... ........................... 316
23 Pulmonary Thromboembolism R. Sheehan and M.B. Rubens . ........................................... 333
24 Pulmonary Edema M. Pistolesi, F. Lavorini, G.A. Fontana, M. Mascalchi, and E.N.e. Milne . ....... 347
25 Drug-Induced Pulmonary Reactions D.A. Lynch ........................................................... 368
26 Environmental Lung Disorders: Mineral Pneumoconioses M. Sperber and K. McConnochie ......................................... 382
27 Environmental Lung Disorders Induced by Organic (Nonmineral) Agents M. Sperber . .......................................................... .401
28 Environmental Lung Disorders Secondary to Inhalation of Toxic Gases, Fumes, and Aerosols D. Novak. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 409
Contents xiii
29 Carcinoma of the Lung M.K. Wood and S.G. Spiro .............................................. 424
30 Rare Tumors of the Lung F. Laurent, V. Latrabe, and M. Montaudon ................................ 441
31 Congenital Malformations of the Lung J.M. Mata, J. Caceres, and J.R. Manzano .................................. 453
32 The Solitary Pulmonary Nodule: Radiologic Assessment J.E. Takasugi and J.D. Godwin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 462
33 Malignant Pulmonary Disorders other than Bronchogenic Carcinoma T. Pirronti, R. Manfredi, and P. Marano . .................................. 485
34 Benign and Malignant Mediastinal Lesions A.R. Wright .......................................................... 499
35 Chest Trauma K. Malagari and Ch. Roussos. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 511
36 The Diaphragm R.D. Tarver and D.J. Conces Jr. 533
37 Benign and Malignant Lesions of the Pleura and the Chest Wall P. Vock ............................................................... 549
38 The Intensive Care Chest E.M. Marom and P.e. Goodman ......................................... 562
Index ................................................................... 583
Contributors
J.Andreu Department of Radiology Hospital General Vall d'Hebron Pg de la Vall d'Hebron 119-129 08035 Barcelona Spain
M.e. Anglade Hopital Henri Mondor Service de Radiologie Creteil Cedex France
Y. Berthezene Department de Radiologie Hopital Croix-Rousse 103 Grande rue de la Croix Rousse 69317 Lyon Cedex 04 France
K.A. Buckwalter Department of Radiology Indiana University Medical Center Indianapolis, IN 46204 USA
J. Caceres Department of Radiology Hospital General Vall d'Hebron Pg de la Vall d'Hebron 119-129 08035 Barcelona Spain
Roberto Cancellieri Instituto di Radiologia Ospedale S. Evgenio Tor Vergata University Piazzale dell'Umanesimo 10 00144 Rome Italy
S.w. Clarke Royal Free Hospital Pond Street London NW3 2QG England
P.L. Clouet Department de Radiologie Hopital Croix-Rousse 103 Grande rue de la Croix Rousse 69317 Lyon Cedex 04 France
J. Collins Department of Radiology University of Wisconsin Hospital and
Clinics E3/311 Clinical Science Center 600 Highland Avenue Madison, WI 53792-3252 USA
D.J. Conces Jr. Department of Radiology Indiana University School of Medicine University Hospital 550 N. University Blvd Indianapolis, IN 46202-5253 USA
J.-P. Derenne Service de Pneumologie et Reanimation Groupe Hospitalier Pitie Salpetriere AP-
HP 47-83 Boulevard de l'Hopital 75651 Paris Cedex 13 France
K.R. Flaherty Division of Pulmonary and Critical Care Department of Internal Medicine University of Michigan Medical Center Ann Arbor, MI 48109-0360 USA
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xvi
G.A. Fontana Department of Critical Care Section of Respiratory Medicine University of Florence Italy
P.Gehr Institute of Anatomy University of Berne Buehlstrasse 26 CH-3000 Berne 9 Switzerland
J.D. Godwin Department of Radiology University of Washington Medical Center Box 357115 Seattle, WA 98195 USA
P.C. Goodman Radiology Department - Thoracic Imaging Duke University Medical Center Durham, NC 27710 USA
N.D. Greyson Department of Nuclear Medicine St Michael's Hospital 30 Bond Street Toronto, Ontario M5B 1 W8 Canada
B.H.Gross Professor and Associate Chairman Department of Radiology University of Michigan Hospitals and
Clinics Ann Arbor, MI 48109-0030 USA
Harumi Itoh Department of Radiology Fukui Medical University Fukui,910-1193 Japan
S. Jouveshomme Service de Pneumologie Groupe Hospitalier Pitie Salpetriere AP-HP 47-83 Boulevard de l'H6pital 75651 Paris Cedex 13 France
E.A. Kazerooni Division of Chest Radiology Department of Radiology
Contributors
University of Michigan Medical Center Ann Arbor, MI 48109-0326 USA
V.Latrabe Unite d'Imagerie Thoracique et
Cardio-vasculaire H6pital du Haut-Leveque CHU de Bordeaux Avenue de Magellan 33604 Pessac France
F. Laurent Unite d'Imagerie Thoracique et
Cardio-vasculaire H6pital du Haut-Leveque CHU de Bordeaux Avenue de Magellan 33604 Pessac France
F. Lavorini Department of Critical Care Section of Respiratory Medicine University of Florence Italy
N. Le Flour Service de Pneumologie Groupe Hospitalier Pitie Salpetriere AP-HP 47-83 Boulevard de l'H6pitai 75651 Paris Cedex 13 France
M.L6pez Department of Radiology Hospital General Vall d'Hebron Pg de la Vall d'Hebron 119-129 08035 Barcelona Spain
D.A.Lynch Department of Radiology Box A030 University of Colorado Medical Center 4200 East Ninth Avenue Denver, CO 80262 USA
Contributors
J.P. Lynch III Division of Pulmonary and Critical Care
Medicine University of Michigan Medical Center Ann Arbor, MI 48109-0360 USA
A. Magalhaes Laborat6rio de Neuroimgem LIM-21 Hospital das Clinicas University of Sao Paolo av Dr Eneas de Calvalho Aguiar 255 Sao Paolo 05403-010 Brazil
K.Malagari 2nd Department of Radiology University of Athens 20 Papadiamaudopoupou Street 11528 Athens Greece
L.Mancini Instituto di Radiologia Ospedale S. Evgenio Tor Vergata University Piazzales dell'Umanesimo 10 00144 Rome Italy
R. Manfredi Department of Radiology Universita Cattolica del S. Cuore ''A. Gemelli" University Hospital 00168 Rome Italy
J.R. Manzano HU Germans Trias Universitat Autonoma Barcelona Spain
P.Marano Department of Radiology Unversita Cattolica del S. Cuore "A. Gemelli" University Hospital 00168 Rome Italy
B.Marchand Department de Radiologie H6pital Croix-Rousse 103 Grande rue de la Croix Rousse 69317 Lyon Cedex 04 France
E.M.Marom Department of Radiology - Thoracic
Imaging Box 3808 Duke University Medical Center Durham, NC 27710 USA
F.J. Martinez
xvii
Division of Pulmonary and Critical Care Department of Internal Medicine University of Michigan Medical Center Ann Arbor, MI 48109-0360 USA
M. Mascalchi Department of Clinical Pathophysiology Section of Radiology University of Florence Italy
M.Mata Department of Radiology Hospital General Vall d'Hebron Pg de la Vall d'Hebron, 119-129 Barcelona 08035 Spain
K. McConnochie Department of Tuberculosis and Chest
Diseases Llandough Hospital Penarth South Glamorgan CF 64 2XW Wales
E.N .C. Milne Department of Radiological Sciences University of California, Irvine Medical Center Orange, CA 92868 USA
M. Montaudon Unite d'Imagerie Thoracique et Cardio-
vasculaire H6pital du Haut-Leveque CHU de Bordeaux Avenue de Magellan 33604 Pessac France
J.-F. Mornex Department de Pneumologie H6pital Cardio-vasculaire et
pneumologique 28 Avenue Doyen Lepine 69500 Bron France
xviii
A.Moscone Instituto di Radiologia Ospedale S. Evgenio Tor Vergata University Piazzale dell'Umanesimo 10 00144 Rome Italy
P.Nesme Department de Pneumologie Hopital Croix-Rousse 103 Grande rue de la Croix Rousse 69317 Lyon Cedex 04 France
J. Nishi Department of Radiology Kumamoto University School of Medicine 1-1-1 Honjo Kumamoto 860-8556 Japan
K. Nishimura Department of Respiratory Medicine Graduate School of Medicine Kyoto University Sakyo-ku Kyoto 606-8507 Japan
D.Novak Institute of Radiology Adenauerallee 23 53111 Bonn Germany
S.Oguri Department of Respiratory Medicine National Minami-Kyoto Hospital 11 N akaashihara Jyouyou-shi Kyoto 610-0113 Japan
G. Pearson Section of Chest Radiology Columbia University College of
Physicians and Surgeons 630 West 168th Street New York, NY 10032 USA
T. Pirronti Department of Radiology Universita Cattolica del S. Cuore "A. Gemelli" University Hospital 00168 Rome Italy
M. Pistolesi Department of Critical Care Section of Respiratory Medicine University of Florence Viale Morgagni 85 50134 Florence Italy
M.Rebner Section of Breast Imaging Department of Diagnostic
Radiology Wm. Beaumont Hospital Royal Oak MI48073 USA
P.Reynaud Service de Chiurgie Thoracique Hopital Laennec Rue de Sevres 42 75007 Paris Cedex 7 France
M.Riquet Service de Chiurgie Thoracique Hopital Laennec Rue de Sevres 42 75007 Paris Cedex 7 France
Ch.Roussos University of Athens Critical Care Department Evangelismos Hospital 45-57 Hipsilandou Street Kolonaki Athens 10671 Greece
M.B.Rubens Department of Imaging Royal Brompton Hospital Sydney Street London SW3 6NP England
N.W. Schluger Department of Medicine
Contributors
Division of Pulmonary Allergy, and Critical Care Medicine
Columbia University College of Physicians and Surgeons
630 West 168th Street New York, NY 10032 USA
Contributors
G. Sergiacomi Instituto di Radiologia Ospedale S. Evgenio Tor Vergata University Piazzale dell'Umanesimo 10 00144 Rome Italy
R.Sheehan Department of Imaging Royal Brompton Hospital Sydney Street London SW3 6NP England
T. Similowski Service de Pneumologie et Reanimation Groupe Hospitalier Pitie Salpetriere AP-
HP 47-83 Boulevard de l'Hopital 75651 Paris Cedex 13 France
A.K. Simonds The Royal Free Hospital Pond Street London NW3 2QG England
G. Simonetti Instituto di Radiologia Ospedale S. Evgenio Tor Vergata University Piazzale dell'Umanesimo 10 00144 Rome Italy
M.Sperber Department of Radiology Hospital Vall d'Hebron University of Barcelona Spain
S. Sperber Department of Medicine Mount Vernon Hospital Rickmansworth Road Northwood Middlesex MA6 2RN England
S.G. Spiro Department of Thoracic Medicine University College London Hospitals Middlesex Hospital Mortimer Street London WIN 8AA England
D.L. Spizarny Department of Diagnostic Radiology Henry Ford Hospital Detroit,MI USA
C. Straus Service Central d'Explorations
Functionnelles Respiratoires Groupe Hospitalier Pitie Salpetriere,
AP-HP 47-83, Boulevard de l'Hopital 75651 Paris Cedex 13 France
J.E. Takasugi Department of Radiology S-113 Puget Sound VA Health
Care System 1660 S. Columbian Way Seattle, WA 98108 USA
M. Takahashi Department of Radiology Kumamoto University 1-1-1 Honjo Kumamoto 860-8556 Japan
R.D. Tarver Department of Radiology Indiana University Medical Center Wishard Memorial Hospital Indianapolis, IN 46202 USA
S. Tomiguchi Department of Radiology Kumamoto University School of Medicine 1-1-2 Honjo Kumamoto 860-8556 Japan
N. Vasile Service d'Imagerie Medicale Hopital Henri Mondor 51 rue du M.de Lattre de Tassigny 94010 Creteil France
P.Vock Department of Radiology University Hospital Inselspital 3010 Berne Switzerland
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D. Westra Department of Radiology Academisch Medisch Centrum Amsterdam Holland
M.K.Wood Department of Thoracic Medicine University College London Hospitals Middlesex Hospital Mortimer Street London WIN 8AA England
A.R. Wright Department of Radiology St. Mary's Hospital Praed Street London W2 INY England
M. Zeiter Service Central d'Explorations
Fonctionnelles Respiratoires
Contributors
Groupe Hospitalier Pitie Salpetriere AP-HP 47-83 Boulevard de l'H6pital 75651 Paris Cedex 13 France
