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Practical Differential Diagnosis for CT and MRI

Eugene C. Lin, MD

Clinical Assistant Professor Department of Radiology University of Washington Attending Radiologist Virginia Mason Medical Center Seattle, WA

Andrew G. Bleicher, MD Assistant Professor Department of Radiology, Division of Neuroradiology University of Pittsburgh Medical Center Pittsburgh, PA

Thieme New York • Stuttgart

Edward J. Escott, MD

Assistant Professor Department of Radiology, Division of Neuroradiology University of Pittsburgh Medical Center Pittsburgh, PA

Kavita D. Garg, MD Professor Department of Radiology Anschutz Centers for Advanced Medicine University of Colorado Health Sciences Center Aurora, CO

David Alexander, MD Radiology Fellow University of Washington Seattle, WA

Thieme Medical Publishers, Inc. 333 Seventh Ave. New York, NY 10001

Executive Editor: Timothy Hiscock Editorial Assistant: David Price Vice-President, Production and Electronic Publishing: Anne T. Vinnicombe Vice-President, International Marketing and Sales: Cornelia Schulze Production Editor: Torsten Scheihagen Chief Financial Officer: Peter van Woerden President: Brian D. Scanlan Compositor: Thomson Digital Printer: Maple-Vail Book Manufacturing Group

Library of Congress Cataloging-in-Publication Data

Practical differential diagnosis for CT and MRI / Eugene Lin

[et al.].

p. ; cm. Includes bibliographic references and index. ISBN 978-1-58890-655-7 (alk. paper)

1.

Diagnosis, Differential—Handbooks, manuals, etc. 2. Tomography—Handbooks, manuals, etc.

3.

Magnetic resonance imaging—Handbooks, manuals, etc. I. Lin, Eugene.

[DNLM: 1. Magnetic Resonance Imaging—methods—Handbooks. 2. Tomography, X-Ray Computed—methods—Handbooks. 3. Diagnosis, Differential—Handbooks. WN 39 P8947 2008] RC71.5.P73 2008

616.07’57—dc22

2008014877

Copyright © 2008 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation without the publisher’s consent is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage.

Important note: Medical knowledge is ever-changing. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may be required. The authors and editors of the material herein have consulted sources believed to be reliable in their efforts to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error by the authors, editors, or publisher of the work herein or changes in medical knowledge, neither the authors, editors, nor publisher, nor any other party who has been involved in the preparation of this work, warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Readers are encouraged to confirm the information contained herein with other sources. For example, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this publication is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.

Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.

Printed in the United States

5 4 3 2 1

TMP ISBN 978–1-58890–655–7

To Satish, Samita and Sandip for their love, support and patience. Thank you to my residents, fellows and clinical colleagues for a lifetime of professional joy.

— Kavita D. Garg, MD

I would like to thank Patty Smith for her help preparing references.

— Edward J. Escott, MD

I would like to thank Bonnie Marston for help in preparing the manuscript. I would also like to thank my colleagues in the radiology department at Virginia Mason Medical Center. In particular, Dr. Neal Conti for reviewing the manuscript and providing many helpful comments.

— Eugene Lin, MD

With gratitude to all who have helped me reach this stage, with appreciation of my family and their continued support, with hopes for a shared future of growth and happiness.

— Andrew G. Bleicher, MD

Contents

Preface

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xiii

List of Contributors

 

xv

BRAIN Edward J. Escott, MD Andrew G. Bleicher, MD Jawad Tsay, MD Melissa Kang, MD Parvez Masood, MD Sunayna Bakaya, MD

 

Tumor and Tumor-like Lesions

 

1.

Peripherally Enhancing Cystic Brain Lesions

 

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Metastases versus Primary Brain Neoplasms

 

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3.

Intraventricular Neoplasms

 

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4.

Tumefactive Demyelination

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5.

Posterior Fossa Neoplasms in Children

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Posterior Fossa Cystic Neoplasms

 

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7.

Cerebellopontine Angle Lesions

 

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Posterior Fossa Cysts and Cerebellar Malformations

 

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9.

Meningeal Enhancement

 

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10.

Sellar and Parasellar Lesions

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11.

Dermoid Cysts and Lipomas

 

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12.

Pineal Region Lesions

 

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Vascular

 

13. Arterial Infarcts versus Venous Infarcts

 

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14. Bilateral Thalamic Lesions

 

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41

viii

Contents

15. Intracranial Hemorrhages

 

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16. Perivascular Spaces versus Lacunar Infarcts

 

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Infection

 

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Intracranial Manifestations of Human Immunodeficiency Virus

 

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Miscellaneous

 

18. Hyperdense and Calcified Lesions on Computed Tomography

 

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19. Corpus Callosum Lesions

 

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20. Abnormal Basal Ganglia Signal on Magnetic Resonance Imaging

 

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21. Hydrocephalus

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22. Restricted Diffusion

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63

HEAD AND NECK Edward J. Escott, MD Sunayna Bakaya, MD Andrew G. Bleicher, MD Mohsin Rahman, MD Melissa Kang, MD

 

Skull

23. Focal Calvarial Lesions

 

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24. Diffuse Calvarial Lesions

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Skull Base

 

25. Skull Base Lesions

 

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26. Jugular Foramen Lesions

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Sinonasal Region

 

27. Sinonasal Lesions

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28. Abnormal Sinus Density and Signal

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Orbit

29. Orbital Vascular Lesions

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30. Orbital Lymphoproliferative and Inflammatory Disorders

 

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31. Optic Nerve-Sheath Complex Lesions

 

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32. Lacrimal Gland Lesions

 

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Salivary Gland

 

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Salivary Gland Lesions

 

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Thyroid Lesions and Calcifications

 

34.

Thyroid Diseases and Lesions

 

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Carotid Space

 

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Carotid Space Masses

 

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Congenital Cystic Neck Masses

 

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Congenital Cystic Neck Masses

 

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100

Contents

ix

Lymph Nodes

37.

Lymph Node Disease

 

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Ear and Temporal Bone

 

38.

Ear and Temporal Bone Lesions

 

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106

Larynx

 

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Vocal Cord Lesions and Paralysis

 

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Carcinomas and Neoplasms

 

40.

Head and Neck Cancer

 

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111

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113

42.

Radiation Changes

 

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115

CHEST Kavita Garg, MD

 

Patterns and Signs

43. The Mosaic Pattern of Lung

 

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44. The Tree-in-Bud

 

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45. Ground-Glass

 

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46. The Halo Sign

 

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47. The Crazy-Paving Pattern

 

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128

48. The Angiogram Sign

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49. The Feeding Vessel Sign

 

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Airways

 

50. Bronchiectasis

 

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51. Tracheobronchomalacia

 

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52. Asthma and Associated Conditions

 

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53. Emphysema

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