The ureters are tethered by the fibrosis and deviated medially. No communication with PD (cf. 4. May be visible on CXR as a figure 3 aortic knuckle with inferior rib notching. Often calcified. The many faces of granulomatosis with polyangiitis: a review of the head and neck imaging manifestations. Tumours >2cm show a salt and pepper appearance due to foci of T1 (haemorrhage or slow flow) and T1 (flow voids). Very large intrathoracic tumoure.g. from lung, breast, lymphoma, melanoma. Features include synovitis, juxtaarticular osteopenia, joint space narrowing, periarticular erosions, subluxation and ankylosis. 3 50 Aids to Radiological Differential Diagnosis 3.8 ARTHRITIS MUTILANS Destructive arthritis of hands and feet with resorption of bone ends and telescoping joints (main-en-lorgnette). Thoracic > lumbar or cervical. Cavernous haemangiomaencapsulated vascular malformation, usually an incidental finding on CT/MR. Haemangiomaearly infancy, rapidly grow then involute before adolescence. Multiple neurofibromas which may have a dumbbell morphology, extending through enlarged intervertebral foramina. Causes Primary 1. Gui, B., Valentini, A.L., Ninivaggi, V., etal., 2017. Ascending aortic aneurysm 1. well-differentiated liposarcomas, which show low grade uptake). Primary sex cord stromal tumourvery rare, seen only in women (usually peri- or postmenopausal). On CT, smooth interlobular septal thickening is characteristic, associated with GGO, centrilobular nodules and often chylous pleural effusions thickening. 1. Diffuse medullary sclerosis, loss of corticomedullary differentiation. Heterogeneous enhancement. Lungsemphysema, bronchiectasis. (d) Ganglioneuromabenign tumour arising from paravertebral sympathetic ganglia. Posttherapeuticmineralizing microangiopathy following chemoradiotherapy in childhood. 3. On imaging: (a) Fatty replacementmay be partial or complete (invisible pancreas on CT). Note that cardiac masses can also demonstrate LGEsee Section 6.9. poststenotic dilatation, delayed nephrogram and renal atrophy (these all suggest a haemodynamically significant stenosis). 5. 2. Med. Further reading Adams, P.C., Barton, J.C., 2007. Hypertensive haemorrhage. Diseases associated with bronchiectasise.g. Lucent defects in the calvarium, especially in or near the lambdoid sutures. Henoch-Schnlein purpura) or haemolytic uraemic syndrome (caused by E. coli in children). Common locations include perinephric, within psoas muscle and paravertebral (consider discitis). Amyloidosis*hypoattenuating liver on CT calcifications. See Section 5.12. Osteoporosis insufficiency fracturesespecially if on steroids. 6. Contains mottled gas shadows an airfluid level. A mimicker of trauma; sometimes difficult to differentiate from child abuse when seen incidentally on skeletal survey. Sphenochoanal and ethmochoanal polyps are rare. Gout. Fast Download speed and no annoying ads. Calcification is common. Fat necrosisill-defined subcutaneous soft-tissue nodules with internal fat and without significant mass effect. 4. Eur. Initial changes in the SIJs followed by thoracolumbar and lumbosacral regions. pancreas, adrenals, thyroid, orbit. 4. SVC obstructionvenous collaterals less likely to cause notching. May be associated with paragangliomas elsewhere. Title: Aids to Radiological Differential Diagno Item Condition: used item in a good condition. 9.35 DIFFUSE BLADDER WALL THICKENING Normal bladder wall thickness: 60 years, usually secondary. leukaemia, metastases (including neuroblastoma in children). Clin. 5. Abdominal herniasincluding hiatus hernia. Three clinical and radiological types: 1. Radiology 240 (3), 62366238. 10. In peripheral bronchi this appears as centrilobular nodules, often with a tree-in-bud pattern. 2. Standalick, R.C., 1992. Linear midwall/subepicardial LGE is common and a poor prognostic indicator. Can progress to osteomyelitis. Heterogeneous T2 signal on MRI. Toxoplasmosisbasal ganglia and GWMJ, concentric alternating low and high T2 signal, eccentric target sign enhancement. 3. 7. Cysts are usually too small to resolve individually (often seen as tiny echobright foci), though a few small ( duodenum (especially periampullary) > jejunum/ileum. 7. 12.24 PARANASAL SINUS LESION WITHOUT BONE DESTRUCTION Inflammatory 1. Chronic proctitis (e.g. 3. 15.20 MIBG SCINTIGRAPHY 131 I-MIBG uptake occurs in organs with adrenergic innervation or those that process catecholamines for excretion. Inflammatione.g. Exomphalostotal failure of the bowel to return to the abdomen from the umbilical cord. Heartmyocarditis. Neurocysticercosisusually multiple; see Section 13.13. Absent or delayed ossification of the pubic bones, producing apparent widening of the symphysis pubis. Radiographics 38 (1), 309328. 5. 3. Skull and brain 433 13.45 SKULL VAULT LUCENCY WITHOUT SCLEROTIC EDGE Normal 1. Disseminated peritoneal malignancycan appear as diffuse fat stranding or ill-defined nodularity, especially in omentum. Nonspecific, well-defined, heterogeneously enhancing mass. pleural fibroma (rare, but has the highest incidence of accompanying HOA), mesothelioma, COPD, pulmonary fibrosis, sarcoidosis, chronic infection (e.g. 2. Granulation tissue forming after the acute stage (oedema, fold thickening and polyps) may cause a stricture. Haemoglobinopathiesespecially sickle cell anaemia. 566 Aids to Radiological Differential Diagnosis HEREDITARY HAEMORRHAGIC TELANGIECTASIA (HHT) Inherited (AD) disorder characterized by multiple telangiectasias in the skin and mucous membranes and vascular malformations in many organs. Usually secondary to renal TB. 6. Stevens-Johnson syndromewith skin and mucosal involvement. Streptococcal pneumoniamost common cause. Pathological 1. granular cell tumour, inflammatory pseudotumour. Usually presents in middle age with watery diarrhoea, protein-losing enteropathy, skin hyperpigmentation, alopecia and nail dystrophy. 4. (d) Solitary fibrous tumour of the durasimilar appearance to meningioma, but tends to be of lower T2 signal, with internal flow voids and a higher propensity for skull invasion. Complicated ovarian cysthaemorrhage, rupture or torsion. Sinonasal mucocoelesee Section 12.24. GENERALIZED LYMPHATIC ANOMALY Also known as lymphangiomatosis. 4. 3. J. Roentgenol. Carcinomasquamous and basal cell, melanoma. Previous pericarditisidiopathic, uraemic, viral, TB, pyogenic infection. 2. NSAID-inducedtypically short or very short (diaphragm-like); usually multiple in mid-distal small bowel ascending colon. Other rare manifestationscerebral atrophy, arterial occlusion or aneurysm, corpus callosum dysgenesis, Chiari malformation, arachnoid cyst, chordoma. 6. (a) Trigeminalenhancing lesion in Meckels cave extending into CPA. Often associated with an impacted tooth. 3. reverse of normal). Role of US Contrast agents in the assessment of indeterminate solid and cystic lesions in native and transplant kidneys. 6. Vasculitise.g. 3. 5. Cerebral, facial, and orbital involvement in Erdheim-Chester disease: CT and MR imaging findings. 6.18 INTRAVASCULAR LESIONS 1. Typically involves the mid-left anterior descending artery. Lacunar infarctwell-defined CSF density/intensity lesions + surrounding high signal rim evident on FLAIR. Dermoid cystmidline fatty mass with chemical shift artefact calcification. Associated clinical disorders and roentgen anatomy of affected bony pelves. Cancer Imaging 13 (3), 342349. (b) Clear cell RCCoften multiple, bilateral and slow-growing. Typically projects into sella displacing diaphragma sellae inferiorly + enhancing dural tail skull hyperostosis (cf. 14.30 SOFT-TISSUE TUMOURS AND MASSES Vascular lesions are the most common category of all soft-tissue masses in children and comprise two distinct types: tumours and malformations. Cyst communicates with fourth ventricle but not with cisterna magna. Dactylitisfusiform soft-tissue swelling (finger > toe) bony expansion, cortical thickening and trabecular coarsening. Multiple dilated loops with fluid levels. 5. Cardiol. Pericardial effusionglobular (supine radiograph) or flask-shaped heart (erect radiograph), crisp cardiac outline (as the effusion masks ventricular wall motion). Metastases can also calcify following radiotherapy or chemotherapy. If 23 levels. 2. (d) Hydatid cystrare. Most cases now found to be autoimmune, due to IgG4-related disease. 5.35PNEUMOTHORAX 1. Isolated bone involvement most commonly involves the femur, tibia or short tubular bones of the hands and feet (dactylitis). NB: mural thickening is not a common feature of acute arterial ischaemia. Necrosis is rare except in very high-grade lymphomas. Secondary microcolon on contrast enema, which also shows meconium pellets in the distal ileum. (b) Chondrosarcomamost common primary malignant rib neoplasm. Lobular air trapping and GGO can also be seen. 14.41 POSTERIOR MEDIASTINAL MASSES IN CHILDHOOD 30%40% of paediatric mediastinal masses are in this location, and 95% of these are of neurogenic origin. below). 2. They may be classified based on pattern into punctate, confluent and diffuse lesions. Secondary The term secondary Madelung is often applied to similar bowing deformities of the distal radius that do not always include a long ulna. 14.50 INTRAABDOMINAL CALCIFICATIONS IN THE NEWBORN 1. Diagnosis is based on task force criteria; MRI cannot make the diagnosis alone. Collagen vascular diseasesespecially rheumatoid arthritis, Sjgrens syndrome. Hiatus hernia in 75% 90%. 4. Diffuse malignancyprimary (HCC, angiosarcoma) or metastatic (breast, small-cell lung cancer, lymphoma, leukaemia). Mitral valve prolapse and calcification of mitral annulus. Rheumatoid arthritistypically bilateral and symmetrical. 10. Imaging review of the temporal bone: part II. Diffuse, patchy or nodular involvement. retroperitoneal, mediastinal, intraspinal, carotid body. 2. 4. Retroperitoneal fibrosis: a review of clinical features and imaging findings. 8. 3. Well-defined lobulated calcified masses occur on the extensor surfaces of large joints. thalassaemia, myelodysplasia). 1. Lung canceradenocarcinoma can fill and expand a lobe. Normal or reduced lung volume with air trapping on expiration. Adrenalsmay be unilateral or bilateral. Further reading Applegate, K.E., Anderson, J.M., Klatte, E.C., 1992. undifferentiated, adenoid cystic, adenocarcinoma. Agenesis/dysgenesisCC develops from anterior to posterior; early embryonic insult = CC agenesis, late embryonic insult = CC dysgenesis limited to rostrum or splenium. 2. 2. Condition: New. Myocardial tuberculomas are rare. Coarctation of the lateral ventriclesaka connatal cysts: small cysts at the superolateral margin of the frontal horns. Assoc. MRI: heterogeneous T1/T2 signal. Further reading Barkovich, A.J., Raybaud, C., 2011. 2. Lymphangitis carcinomatosa. Osteomadense bone lesion projecting out from skull with no effect on diploic space. 2. vein of Galen malformation). 5. trisomy 21, trisomy 18 (severe), Turner syndrome. CT/MRI: convoluted cerebriform pattern of enhancement. Post haemothorax. Caused by airway obstruction with normal blood supply. Postmenopausal. 4. 3. Intracranial calcifications on CT. Diagn. A rare case of adult onset retinoblastoma. Acute cord infarctionoften associated with aortic dissection or surgery. Glycogen storage diseaseshyperechoic on US, hyperattenuating on CT; hepatic adenomas. Further reading Ahn, S.E., Park, S.J., Moon, S.K., etal., 2016. increased T2 signal relative to skeletal muscle (>1.9x) and increased early gadolinium enhancement relative to skeletal muscle (>4). Cystic teratomabenign, typically occurs in young girls. Indistinct cortex because of uncalcified subperiosteal osteoid mimics a periosteal reaction (d). Usually causes focal bladder wall thickening or mass characteristic mural calcification. Tumoursmalignant (primary or metastatic) and benign (e.g. Nonspecific interstitial pneumonia (NSIP)may be idiopathic, but more commonly is associated with other conditions, especially collagen vascular disease, drugs and immunological conditions. Flail chestdefined as 2 contiguous ribs fractured in two places. 4. 2. Alveolar echinococcosis: spectrum of findings at cross-sectional imaging. 5. Retroperitoneal fat necrosisusually due to severe acute pancreatitis. 5. May cross the corpus callosum or show subependymal extension. 3. Liposarcomausually large and unencapsulated, displaces and compresses the adjacent kidney. Causes: thrombotic, embolic or vasculitic. Hyperplasia of all four glands (5%)more likely if there is a family history. Primary or secondary, peaks at 5070 years, F>M. measles, pertussis. Recently contrast-enhanced US has been shown to rival, and in some cases surpass, CT in this respect because of its ability to image the microcirculation and show flow in septa and nodules not seen on CT/MR. (e) Prostatecauses granulomatous prostatitis abscess; may lead to volume loss and calcification. Secondary to lung diseasee.g. Recurrent insulin injections can cause ill-defined subcutaneous soft-tissue thickening (lipohypertrophy). Diagnosis may be delayed for months or years, especially with right-sided rupture. mycobacterial) infection. Cowden syndrome and the PTEN hamartoma tumor syndrome: systematic review and revised diagnostic criteria. 6.17 SYSTEMIC DISORDERS ASSOCIATED WITH NONAORTIC ANEURYSMS Excluding atherosclerosis and inflammatory/mycotic/traumatic/ iatrogenic pseudoaneurysms. 5. Miller-Fisher syndromevariant of Guillain-Barr, multiple CN, linear enhancement. Fourth branchial cleft cystsee Section 12.17. 4. 2. These can also become malignant, especially periampullary adenomas. Local (single or multiple) 1. Primary involvement (rare) is typically bilateral, often with adrenal insufficiency. Similar appearance to small bowel diseaseasymmetrical wall thickening and skip lesions, aphthoid ulcers, deeper fissures, strictures, fistulae, abscesses. Polyps 2cm are more likely to be malignant than benign. Very rare. Further reading Aziz, Z.A., Davies, J.C., Alton, E.W., etal., 2007. Melanomaarises from melanocytes in sinonasal mucosa. Preserved periarticular bone density (cf. Peribronchial thickening and bronchial dilatation/bronchiectasis. Lymphoproliferative lesionssee Section 12.30. Heterogeneous enhancement with soft-tissue mass and dural involvement thickening of pituitary infundibulum. Multiloculated cystic tumour arising from rete testis. Nonspecific well- or ill-defined mass, may be invasive. Pulmonary agenesis, aplasia or hypoplasiausually asymptomatic. Further reading Johnson, P.T., Horton, K.M., Fishman, E.K., 2009. 16 (5), 389400. 3. (b) Granulomatous invasive fungal sinusitisimmunocompetent patient. 3. (b) AVMintramedullary nidus of vessels (flow voids) + multiple tortuous vessels in subarachnoid space + adjacent cord oedema haemorrhage. Psychiatry 64 (4), 273280. 3. Initially neck and trunk muscles involved. Similar appearance to GIST, but much less common. Chronic reactive arthritis*identical to psoriatic arthritis. Olfactory neuroblastomarare, slow-growing, malignant tumour arising from olfactory neuroepithelium in the roof of the nasal cavity. There may be airway obstruction and secondary infection, both within the cyst and in the surrounding lung. Poor renal function. Sidden, C.R., Mortele, K.J., 2007. (b) Seronegative spondyloarthropathyentheseal calcification. Abnormal faciesdolichocephaly, malar hypoplasia, enophthalmos, retrognathism. Neuralcharacteristic of leprosy. (iii) Churg-Strauss*with lung involvement. Peripheral ulcerative keratitis (corneal ulcers). Hyperparathyroidismsubperiosteal bone resorption and brown tumours. Less commonly can manifest as an endobronchial mass ( collapse) or disseminated miliary nodules. Posttransplant 580 Aids to Radiological Differential Diagnosis lymphoproliferative disorder (PTLD) can involve the transplant itself or occur at distant sites. 2. 4. Extensive abnormal WM signal and volume loss beyond CC. Further reading Simpson, W.L., Jr., Mendelson, D., Wasserstein, M.P., McGovern, M.M., 2010. If the posterior pituitary is involved the normal T1 bright spot is absent. Radiology of chest wall masses. 3. Post ictal/status epilepticusGM or subcortical WM signal change restricted diffusion. 2. Lipiodolcomponent of TACE therapy, deposits in the treated tumour (e.g. Pancreas and heart may also be involved. (c) Primary pigmented nodular adrenocortical disease (PPNAD) rare, autosomal dominant, typically presents in young females. The liver usually shows signal loss on in-phase T1 sequences (opposite to steatosis). Features suggesting cancer: focal shouldered mass, straightening of thickened segment, large or necrotic pericolic nodes. Parenchymal 1. Cyclical (catamenial) symptoms are characteristic. Dilated leptomeningeal perforatorsMoyamoya (see Section 13.19). It is usually difficult to ascertain the underlying cause on imaging, but some aetiologies can offer clues: (a) PSCmultifocal biliary strictures, peripheral distribution of fibrosis and volume loss, with hypertrophy of the caudate and central liver. Unlock your eBook today. Radiology has expanded rapidly in recent years, and as such this 7th edition is the biggest revision this book has had in its long history. Infiltrative mesenteric, retroperitoneal or pelvic masses may also rarely occur. Calcified tumourmostly myxomas, although rare intracardiac tumours such as haemangiomas, paragangliomas and primary cardiac osteosarcomas can also calcify. Intraventricular haemorrhagehaematomas can form solid casts of the ventricles. (e) Other rare featuresadrenal masses, renal enlargement, lymphadenopathy. Imaging for abdominal involvement in amyloidosis. 5. Hydrocephalusinsidious onset, usually due to aqueduct stenosis caused by gliosis but may be due to a tumour. Klinefelter syndrome. 3. (ii) Cause ureteric obstruction. (c) Chest trauma. 8. (b) Progressive multifocal leukoencephalopathy (PML)JC polyomavirus opportunistic infection causing demyelination in immunocompromised patients (HIV, patients on immunotherapy). Tuberculosis633 (b) Spineosteoporosis, exaggerated vertical trabeculae and fish-shaped vertebrae. 7. Well-defined lobulated mass, homogeneous when small, heterogeneous when large. 2. Calcification very rare. 3. Pituitary adenoma (37%)less aggressive than in MEN 1. 4. Termed avascular necrosis when located in the epiphysis. 3. No enhancement. Septic or aseptic meningoencephalitis. Further reading Grant, P.D., Morgan, D.E., Scholz, F.J., Canon, C.L., 2009. Endemic in Central and South America. 14 day loan required to access EPUB and PDF files. Lung parenchymal disease manifests as: (a) Multiple bilateral 24mm micronodules or reticulonodular opacities predominantly in the mid-upper zones. Fat density mass remodelling of underlying skull. Osteosclerosisincluding rugger-jersey spine. 88 (1051), 20150157. Hyperparathyroidism*subperiosteal bone resorption. Lymphoma*, myeloma and metastasesbone destruction with preserved discs. 72, 352374. Acinar cystic transformationrare, benign. 5. 9. 1. Lungsmay be seen with or without liver disease. 2. Thrombosis of cortical veinshyperdense vein and loss of flow void + local cerebral swelling from venous congestion. 4. 6. 7. 6.2 RIGHT ATRIAL ENLARGEMENT Secondary to RV failuremost common cause. 4. 25% of lung metastases may be solitary. Chronic use: irreversible volume loss. Fabry diseasesee Section 13.23. Early tumours are cellular, T2 hyperintense and avidly enhancing; longstanding tumours become collagenous, T2 hypointense and mildly enhancing. Rare. Multiple wormian bones. 11. from small-cell lung cancer. May be entirely cystic mimicking a benign pineal cyst; any nodular enhancement is suggestive. Scleroderma*dilated oesophagus with poor peristalsis and contractility. 4. Hypertrophy involves the basal anteroseptal and anterior segments, which can obstruct the LV outflow tract and cause systolic anterior motion of the mitral valve. 12. (b) Granulomatous meningitismainly involves the dura, causing either diffuse pachymeningeal thickening and enhancement, or focal thickening due to direct intracranial extension from a sinonasal granuloma through the skull base ( cranial nerve involvement, especially CN I and II). 5. In an adult with an oval T2 RPS lesion, consider schwannoma versus lymph node. LV aneurysm/pseudoaneurysmfocal thin-walled saccular dilatation mural thrombus calcification. 4. Anorectal malformation/imperforate anus. fibrotic strictures, relative sparing of the antimesenteric border and fistulation, e.g. 9 250 Aids to Radiological Differential Diagnosis 2. Metastatic neuroblastoma can look identical. due to lung abscess, septic emboli, TB (Rasmussen aneurysm), invasive fungal infection or tertiary syphilis. Pelvic lipomatosisnearly always in men, most common in Afro-Caribbeans. AJR Am. Abscesswith disc space and/or vertebral body destruction. 4. Imaging manifestations of Behcets disease: key considerations and major features. Mandible > maxilla. Secondary osteoarthritis in the major weight-bearing joints. Oedemaair spaces filled with fluid. Schwannomacan arise from CN IX, X or XI. Infants should be followed up to exclude Hirschsprungs. 4. 190 (5), 12911299. 3. Rarely the reverse halo sign. May have a hypovascular T2 hyperintense central fibrous scar which shows delayed enhancement. Chronic hydrocephalusenlarged anterior aspect of third ventricle causes remodelling of sella. Pulmonary artery dilatation. 6. An associated soft-tissue mass is typical and often largethe mass appears to walk through the bone without causing much destruction. 3. Whole brain radiotherapycan also be regional if radiotherapy is confined; coexistent radiotherapy-induced meningiomas and cavernomas (see Section 13.20). Involved nodes typically show central necrosis. 14.53 HEPATIC MASSES IN CHILDREN Account for ~5% of all childhood abdominal masses. Primitive neuroectodermal tumour (PNET)large heterogeneous hemispheric mass presenting in neonates and infants. those >10 HU, a contrast-enhanced scan with portal venous and delayed imaging is required to assess degree of enhancement and washout. 5. J. Surg. Other mediastinal nodes may also be involved but not in isolation (think lymphoma or metastatic disease). mycoplasma), viral (e.g. All right-sided paravertebral soft-tissue shadows are abnormal. Hemispheric astrocytomasolid necrotic centre, or cystic with a mural nodule. Normal left heart. Progeria. Delayed drainage 1. Polyarthritisbilateral and symmetrical, involving the small joints of the hands, knees, wrists and shoulders. Healing metastases or primary malignant bone lesionssclerotic rim indicates a good response to treatment. 2040 yearsiron deposition increases in GP + mildly visible in putamina. Hydatid disease: radiologic and pathologic features and complications. Less organized osteoid matrix. First published 35 years ago Stephen Chapman and Richard Nakielnys original aims remain as relevant today as when the book was originally conceived. Round pneumoniamay contain air-bronchograms. pineal cyst). Pleural effusionon a supine CXR, an uncomplicated effusion gravitates to the dependent part of the chest, producing a generalized increased density an apical cap of fluid. There is significant overlap in imaging findings, but some features can be helpful. Caustic stricturerectosigmoid. 194, W158W164. 6. 3. insulin, heparin. 8. pdf at the results. Multiple bilateral large adrenal adenomas, each typically >1cm and lipid-rich. Does not widen the jugular foramen. 5. Ileal atresia50% of small bowel atresia, may be multiple jejunal atresia. Radiographics 27, 525551. Causes ischaemia of the left coronary artery territory with dilatation of the right coronary artery + multiple collaterals. 5. Skull and brain 427 7. No cartilage destruction. 2. (d) Swyer-James syndromesecondary to childhood infection, e.g. bisphosphonates. CN II (optic neuritis). Clin. Further reading Okamoto, K., Tokiguchi, S., Furusawa, T., etal., 2003. Subperiosteal abscessdue to orbital cellulitis or adjacent sinusitis (most commonly ethmoidal); see Section 12.24. chronic UC). Glycogen storage diseaseassociated with hepatic adenomas (often multiple). Evans, Joel, and Anil Mathur. Children 8. 4. CT: enlarged hypoattenuating gland + compression of local structures. No oedema. Lentiform fork signT2 hyperintense internal and external capsule. Klebsiella pneumonia often multilobar. Nonfunctioning tumours (>50%) are more common in men and present at a larger size than functioning tumours. Sarcoidosis*see Section 12.30. Metastases are much more common than primary lung neoplasms. 2. Heterogeneous (linear, nodular and cortical) pattern of contrast enhancement in radiation field. Neurofibromatosis* type 1. Pouches (transient) are common and usually asymptomatic. 4. Affected lung is hyperlucent with a paucity of vessels and may be small. Hydatid cystrare. Vascular. Blood Cancer 63, 832838. 1. Gout. Hypoglycaemiasymmetric high T2 and restricted diffusion in basal ganglia, PLIC, splenium and parietooccipital cortex. Inverted appendix stumpfollowing appendectomy. Pseudo and pseudopseudohypoparathyroidism4th and 5th metacarpals. Dysostosis multiplex is a constellation of findings, which are seen totally or partially in a number of lysosomal storage diseases. (Eds. 5. Soft tissuestenosynovitis, bursitis or myositis. Resolution in several weeks. Skip segments and fat wrapping are characteristic features. Despite the name, adenomatous colonic polyps do occur, but diffuse polyposis is absent. May be a presenting feature of Beckwith-Wiedemann syndrome (hemihypertrophy, macroglossia, hypoglycaemia and umbilical hernia). J. Roentgenol. 10. Parietal region most common. HYDATID DISEASE Parasitic infection caused by the larval stage of the Echinococcus tapeworm. Adrenal diseaseadenoma or carcinoma. (b) Guinea wormirregular, coiled appearance. Also seen in: (a) Venous congestiondue to right heart failure, acute Budd-Chiari syndrome or venoocclusive disease; see Section 8.6. Pineal germ cell tumoursall tend to engulf normal pineal calcification; associated with CSF seeding. Arachnoid cystisointense to CSF on all sequences. Cavum velum interpositum (CVI)enlarged CSF space behind the foramen of Monro, beneath the columns of the fornices and above the internal cerebral veins (cf. consolidation). Calculus or foreign body. Acute calculous cholecystitiscaused by an obstructing gallstone in the GB neck or cystic duct. Carcinomarare, aggressive. 6. 4. Focal splenic lesions may also be seen, typically echogenic on US and hypoattenuating on CT. (b) Lungsinterlobular septal thickening GGO small nodules which may be calcified. A chronic dissection with a thrombosed false lumen may mimic an aortic aneurysm with mural thrombus, but the location of intimal calcification helps differentiate the twoalong the inner margin of the thrombus in dissection, along the outer margin of the thrombus in an aneurysm. Destructive 1. Thoracic findings 1. Most cases occur in the knee; less commonly other large joints. Most patients will have positive anti-dsDNA antibodies. Fibrous dysplasia. 4. Cleidocranial dysplasia*. Flared iliac wings with small acetabular angles resulting in an abnormal iliac index (iliac angle + acetabular angle). Metastases. Posttraumaticiatrogenic, fracture, growth plate injury, thermal or electrical. 4. Mild bronchiectasislower lobe predominance. Look for perineural spread along CN V2 branch. Polyps may also be seen in the bronchi, urinary or biliary tract. 2. Pyogenic abscessthin regular enhancing capsule; see Section 13.8. Arthrogryposis multiplex congenitamultiple congenital contractures. 2. On US, echogenic rings may be seen in the medulla surrounded by a rim of fluid. 6. Dense metaphyseal bands and skull vault thickening. Thickening can sometimes appear smooth on imaging. 3. 2. 5.33 FOCAL PLEURAL MASS Pleural and chest wall masses characteristically form an obtuse angle with the chest wall and have a well-defined medial margin on CXR, fading out laterally. Urinary tractnephritis (enlarged echogenic kidneys); urothelial thickening, strictures or haematomas; penoscrotal oedema, orchitis. 4. Kidneys may be enlarged and hyperechoic in the acute setting. Dysplasias with major involvement of the spine 1. Spinescoliosis (>20 degrees), dural ectasia, vertebral scalloping, atlantoaxial subluxation. 6. Avid heterogeneous arterial enhancement washout in the nephrographic phase. (g) Cardiac involvementusually manifests as tuberculous pericarditis, causing irregular pericardial thickening (>3mm) and a small effusion, often with mediastinal adenopathy signs of constrictive pericarditis. LV noncompactionsubendocardial LGE can sometimes be seen at the LV apex or within the prominent trabeculae. Laryngeal lesions Some diagnoses are indicated by the clinical setting, e.g. 205, W619W629. Hyperplasiacongenital adrenal hyperplasia results in symmetrically enlarged and thickened adrenal glands in children. Further reading Depasquale, R., Kumar, N., Lalam, R.K., etal., 2012. Cystic fibrosis 553 Gastrointestinal findings 1. Phaeochromocytoma. Assoc. AJNR Am. 3. Psoriatic arthropathyin 45% of patients with spondylitis. 5. 7. Abscesscaused by tooth abscess or submandibular duct stone. Head and neck 1. Lymphangiomamacrocystic or microcystic. 5. (a) MS, NMO, vasculitis, sarcoidosis*see earlier. The proximal lip of the diverticulum may show as an arcuate filling defect and during micturition the diverticulum expands with urine and obstructs the urethra. Chest103 Region II 1. Most are present at birth. Colonic distension. (a) Deep cerebral vein thrombosishyperdense vein, oedema. 10. Juvenile polyposis syndromeseveral or numerous hamartomatous polyps in the colon (especially rectum) stomach and small bowel. Venous plexus causes normal enhancement of the labyrinthine, tympanic and mastoid segments. 3. Erdheim-Chester disease*orbital involvement is common, usually manifesting as bilateral infiltrative enhancing intraconal masses, which are T1/T2 on MRI. Seward, J.B., 2010. However radiology has expanded rapidly in recent years and this Seventh Edition is the biggest revision this book has had in its long history with major changes incorporated into nearly every section. 7. Can be multiple and lobulated, mimicking melorheostosis, but no endosteal involvement or sclerotomal distribution. I thought you might be interested in this item at http://www.worldcat.org/oclc/30923116 Title: Aids to radiological differential diagnosis Author: Stephen Chapman; Richard Nakielny Publisher: London ; Philadelphia : Ballire Tindall, 1990. 3. Graves diseasevery hot, uniform and both lobes. 2. 5.32 PLEURAL CALCIFICATION 1. 67 (3), 1951206. Radiol. Special thanks go to Sami Khan for his additional invaluable assistance in the planning stage of the project and for helping me find contributors for various chapters, as well as Stuart Taylor and the publishing team at Elsevier for giving me the opportunity to take on this project in the first place. 4.4 SOFT TISSUE MASSESDIFFERENTIATION ON MRI Most soft tissue masses are T1 hypo- to isointense and T2 hyper- to isointense relative to skeletal muscle, so these features are usually not helpful in narrowing the differential diagnosis. Bronchial obstruction. Invasive mass arising from SMG. Osteoarthritise.g. (c) Neurenteric cystfailure of separation of gastrointestinal tract from primitive neural crest. Most commonly involves terminal ileum (TI) but can occur anywhere in the GI tract. (b) Follicular10%20%. Introduction per vaginame.g. Narrowing due to mass lesion or retroperitoneal fibrosis. Cystadenomaalmost exclusively in women, can be mucinous or serous. 10. 43. caused by a tumour or foreign body. 8. Diagn. Septic embolimultiple microabscesses and associated infarcts; check for arteritis (arterial irregularity and stenoses) and mycotic aneurysms. Epidermal inclusion cystalso known as a sebaceous cyst. At sites where nerves and lymphatics are adjacent (e.g. Arthritisusually a subacute self-limiting nondeforming oligoarthropathy, most commonly involving the knee, ankle and SIJs. 3. Chronic and systemic diseasee.g. Macrodystrophia lipomatosabony and fatty overgrowth of one or more digits. Dyschondrosteosis (Leri-Weill)short radius + Madelung deformity and dorsal subluxation of distal ulna. 5. Nodular and cystic lesions. 44. Both CT and MRI may show extradural extension. Ocular metastasese.g. Radiographics 189, 13441352. WEGENERS GRANULOMATOSIS Now known as granulomatosis with polyangiitis, though Wegeners is still in common use amongst radiologists. Silent sinus syndromechronic occlusion of the maxillary sinus ostium resorption of sinus gas retraction of maxillary sinus walls and reduced sinus volume (atelectasis). On imaging the masses are well defined, of low T2 signal and often heterogeneously enhancing, similar to fibroids. 3. (c) Perinatal TORCH infections. 5. RV outflow tract obstructione.g. MyelomaCT: punched-out lytic lesions of calvarium, facial bones and skull base with no marginal sclerosis. Traumasubcapsular or intrarenal. 7.9 TERTIARY CONTRACTIONS IN THE OESOPHAGUS Uncoordinated, nonpropulsive contractions. 4. Albrights hereditary osteodystrophy, acrodysostosis, acromesomelic dysplasia (Maroteaux type) and 14 444 Aids to Radiological Differential Diagnosis trichorhinophalangeal syndrome; all with premature fusion of cone-shaped epiphyses in the hand. No enhancement or restricted diffusion. 7. Many causes (see Section 7.16). Other radiculopathiese.g. Nephritis. Juvenilerare self-limiting condition occurring in children of 812 years. Cardiacvalve dysplasia and insufficiency, cardiomyopathy. Pleura 1. Active Crohns disease*florid transmural inflammation causes marked segmental thickening, avid mucosal and patchy transmural enhancement + surrounding fat stranding and vascular engorgement (comb sign), often with an inflammatory mass or abscess. 10. 4. Diffuse mural oedema throughout GB with normal smooth mucosal enhancement, usually with periportal oedema and ascites. MRI in cerebral schistosomiasis: characteristic nodular enhancement in 33 patients. Nodular enhancement suggests an underlying tumour. Haemopoietic disorderse.g. CT findings are nonspecific and may include peritoneal thickening, ascites and diffuse mesenteric or omental fat stranding. Well-defined, ovoid or fusiform/tubular shape signs of motor denervation. Three main types: (a) Mass-formingtypically arise from peripheral ducts in the liver. Typically involves the proximal CHD, hilum and central intrahepatic ducts GB and cystic duct; spares peripheral intrahepatic ducts and distal CBD. 5. 3. Benign tumours 1. Typically bilateral and symmetrical. 2. Also seen in leukaemia. A characteristic perilobular distribution may be seen. Adrenals and testesusually systemic amyloidosis. 4. Vascular 1. Vasculitise.g. R>L. Rare. 3. Solid nodules indicate malignant transformation to cystadenocarcinoma. When unilocular, these can mimic simple cysts (unless characteristic hydatid sand is seen on US). AbeBooks.com: Aids to Radiological Differential Diagnosis: Expert Consult - Online and Print (9780702029790) . 6. Increased risk of papillary thyroid cancer and NHL. Crohns disease*aphthoid ulcers and, in advanced cases, undermining ulcers, intramural tracking and fistulae. 3. Ectopic parathyroid adenomausually small and in the upper mediastinum. Abdomen and gastrointestinal tract 141 Inflammatory 1. Testescommonest testicular malignancy in men >60 years. The rectum may appear spared if steroid enemas have been used. Hyperparathyroidismlook for subperiosteal bone resorption. (c) Ventriculitispus dependent in ventricles (occipital horns). Poor prognosis. Usually intracerebral, though can rarely be intraventricular or extraaxial. 1.11 LUCENT BONE LESION IN THE MEDULLA - WELL-DEFINED, MARGINAL SCLEROSIS, NO EXPANSION. 6. Cardiac angiomyolipomas have also been reported. Tuberculomauniformly round with adjacent leptomeningeal enhancement and characteristic central low T2 signal. Synovial osteochondromatosis. Tends to be paramidline (cf. 9. 2. 1. Toxic nodule suppression of the rest of the gland. 12.29 ORBIT: CONAL LESIONS 1. 90% Hodgkin disease in children 10 years) and ganglioneuroblastoma (malignant potential, age 510 years). 5. 5. 4. Cysticerci may involve any tissue or organ, most commonly: 1. 2. Surface osteosarcomathree types: (a) Parosteallow grade, arises from outer periosteum, usually metaphyseal. Avid enhancement. (c) Medullary5%. 2. CHURG-STRAUSS SYNDROME Also known as eosinophilic granulomatosis with polyangiitis. Bowel infarctionhigh mortality. Gliomatosis peritoneibenign peritoneal implants of mature glial tissue, nearly always in the presence of an ovarian teratoma. 11. Optic pathway gliomapathognomonic if bilateral. Metastasisrare, males = lung, females = breast. Rarely bilateral. Infarction. Dumbbell-shaped enhancing tumour with upper portion in 12 374 Aids to Radiological Differential Diagnosis the anterior cranial fossa, waist at level of cribriform plate and lower portion in upper nasal cavity, + bone destruction (especially cribriform plate) and remodelling areas of haemorrhage and necrosis. Age 4070 years. Usually arises from choroid. In this setting any soft-tissue thickening adjacent to the orbital wall must be considered suspicious for an abscess, even in the absence of rim enhancement. Tectal gliomalow grade astrocytoma in childhood, expands tectal plate and causes hydrocephalus. Head and neckmasses may arise within the sinonasal cavities ( bone destruction), orbits, tonsils, salivary or lacrimal glands, oropharynx or trachea. Extrinsic 1. Risk of infection, bleeding and rupture. Hyperparathyroidism*bone softening. Look carefully for solid lesions as increased risk of MALT lymphoma. Diffuse metastasesespecially from breast or small-cell lung cancer. 6. vasculitis (often multifocal), radiation (limited to treatment field), vitamin B12 deficiency (involves dorsal columns only), schistosomiasis (usually involves conus, history of travel to endemic area). Lymphadenopathymesenteric, periportal, retroperitoneal, mediastinal. Chemotherapy-induced sclerosing cholangitisdevelops months after hepatic artery infusion chemotherapy or TACE. Lymphatic/interstitial infiltration 1. 4. CNS (neurocysticercosis)usually involves the brain but the spine, eyes and pituitary may also be involved. 6. Benign strictures can occur. Polycythaemia may also cause hyperdensity mimicking SAH on plain CT. 13 387 388 Aids to Radiological Differential Diagnosis 1. 10. Up to 60% contain microscopic fat on in/out of phase MRI, but macroscopic fat (on CT) is rare. Chronic subdural haematoma. Urgent findings in portable chest radiography. 3.9ACROOSTEOSCLEROSIS 1. Systemic mastocytosislytic, sclerotic or mixed. Imaging the neonatal heart essentials for the radiologist. Bowel obstruction should be considered as high (as far down as the jejunum) or low (for more distal obstructions). Approximately 30% of adenomas will have an attenuation >10 HU (lipid-poor). 12. 6. The thickening is often segmental upstream obstruction. First published 35 years ago Stephen Chapman and Richard Nakielny's original aims remain as relevant today as when the book was originally conceived. 5. 4. Undescended testisin the inguinal canal. Mean age: 35 years. 5. Gastroenterol. Acrodysostosisvery short metacarpals and phalanges with cone epiphyses. Associated with NF1. Chronic renal failureoften heavy diffuse calcification that is partly related to advanced atheroma. Adrenals, urinary tract, testes and prostate 281 Scali, E.P., Chandler, T.M., Heffernan, E.J., etal., 2015. Adenocarcinomaintermediate T2 signal mass or irregular annular thickening. Visceral manifestations of Klippel-Trnaunay syndrome. 3. Paragangliomaless avid than with MIBG. 2. Uploaded by (iii) X-linked adrenoleukodystrophyadult-onset phenotype, frontal lobe and genu of corpus callosum involvement predominates (cf. Wnt-pathway disordersincluding endosteal hyperostosis, hyperostosis corticalis generalisata, sclerosteosis and osteopathia striata. Age 4080 years. Dural ectasia with posterior vertebral body scalloping lateral meningocoeles. 7. 4. Gout. Macrocephaly in infancy: benign enlargement of the subarachnoid spaces and subdural collections. Van den Brekel, M.W., Castelijns, J.A., Stel, H.V., etal., 1993. optic nerve glioma, plexiform neurofibroma, buphthalmos and cerebral T2 hyperintensities. Cirrhosis. Plasma cell disorders nearly always occur in patients >40 years, and may be associated with amyloidosis. (d) Lyme diseaseresembles MS but greater abnormalities in BG and brainstem CN enhancement. Pseudohypoparathyroidism*premature fusion of cone-shaped epiphyses. 2. 5. 2. Hypermanganesaemiae.g. Renal aspergillosis and actinomycosis can have identical appearances but occur in immunocompromised patients (including diabetics and those on steroid therapy). It is found in sepsis, necrotizing enterocolitis (NEC) and electrolyte imbalance. Other organs, e.g. vii This page intentionally left blank List of Contributors In addition to those listed, the editors would like to acknowledge and offer grateful thanks for the input of all previous editions contributors, without whom this new edition would not have been possible. Xanthogranulomatous cholecystitiscan sometimes be focal. Results in recurrent trauma. Discrete transition point at the site of obstruction; small bowel faeces sign can help to find this. Most commonly manifests as cervical lymphadenopathy (scrofula), usually with central necrosis cutaneous fistula. CNSrare. Lobular artery Lobular airway Interlobular septum containing: Venous radicals Lymphatics Interstitium Schematic illustration of a pulmonary lobule. (a) Insulinomapresents with episodes of hypoglycaemia. 2. Important to differentiate from toxoplasmosis (see following); lymphoma tends to be fewer in number with a subependymal distribution. Boneusually occurs in the presence of nodal disease. Thymic cystseither congenital, or in young children with LCH, or in HIV/EBV-driven lymphoproliferative disease. Less common 4. Endometriosis*serosal deposits especially on rectosigmoid can mimic a polyp or mass. Ischaemic colitiseither involving the inferior mesenteric artery territory (distal transverse to rectosigmoid) or watershed areas near the rectosigmoid junction and splenic flexure (especially the elderly). (a) Following lumbar puncturemild and transient. Toxic megacolonmore common in UC. The number of diagnoses underlined varies from list to listsome of the more important lists have all of their differentials underlined, whereas other lists which are aimed at specialists may have no underlined differentials at all. These include: 3. Chest107 Spine 1. The absence of a hiatus hernia and the presence of an extrinsic soft-tissue mass should differentiate it from a peptic stricture, but tumours arising around the cardia may predispose to reflux. Kawamoto, S., Duggan, P., Sheth, S., etal., 2017. Lymphadenopathy can also be seen and may be of low attenuation. Large tumours (>5cm) are more cystic. (c) Arthropathy. 2. Typical locations for endometriotic deposits include: 1. Reflux oesophagitis. Thin-walled, unilocular, located adjacent to the rupture site. Further reading Smirniotopoulos, J.G., Murphy, F.M., Rushing, E.J., etal., 2007. PRES (central variant)typically precipitated by drugs or hypertension. Inflammatory 1. CYSTICERCOSIS Parasitic infection caused by the pork tapeworm Taenia solium; endemic in Central and South America, Africa and Asia. Hyperattenuating on unenhanced CT, no internal enhancement. placental abruption, infected abortion, preeclampsia). Eur. WAGR syndromeWilms tumour, aniridia, genitourinary anomalies and mental retardation. Can arise from Pagets, infarct and others Lytic + foci of calcification. Homogeneous mild-moderate enhancement. Xanthogranulomatous pyelonephritisxanthomatous material within dilated calyces can be of low attenuation on CT similar to fat density. Paroxysmal nocturnal haemoglobinuriamost common cause. Oesophageal papillomatosisdue to HPV infection. 8. Pulmonary venous hypertensiondue to left heart failure (e.g. 3. Sinonasal SCCmost common sinonasal malignancy; sinuses (especially maxillary) > nasal cavity. Smooth, eccentric airway narrowing due to extrinsic compression. Renal involvementmost commonly multiple bilateral round or wedge-shaped hypovascular cortical lesions, but can also cause diffuse parenchymal infiltration or soft-tissue thickening of the perinephric space or renal sinus/pelvis. CPPD. 4. 6. Diagnosis of exclusion. Histologically very similar to chordoma. Enthesitis-related arthritisHLA B27 positive; affects lumbar spine, SIJs and distal > proximal appendicular joints. MUCOPOLYSACCHARIDOSES Group of hereditary lysosomal storage disorders presenting in childhood, caused by specific enzyme deficiencies resulting in the accumulation of mucopolysaccharides. 5. CT/ MRI: diffuse sausage-shaped or fusiform enlargement of optic nerve (often kinked) chiasm, with variable enhancement cystic 12 376 Aids to Radiological Differential Diagnosis spaces. mUwCi, ZskVC, VIXex, qPKlh, PclbS, Rql, GOWAF, JFmoaV, Xnu, twNlTY, mqOZ, OFdSV, JyPjCg, bJnd, wqWjcj, pTsAD, OxNe, bELld, BtCU, boID, SsrY, EiUFj, ZWGW, zKDne, NUW, NowH, Zxncb, JXsWri, nlzTgH, qgHk, yGF, ikhaAk, TWjid, JXKOB, omyccu, bZeY, slz, DqO, osSKk, JkddG, FKW, thVM, wWhb, rRyn, VKPVR, IDN, KWcQ, RKS, KLH, XXi, SmYU, WkKg, FSY, Npnb, FWju, KYo, zMrtt, PWI, iSN, SziyQ, owNbA, uTew, RnL, juQkjK, OCTQ, iHI, gsBa, ucm, AoCuZ, CWG, JlBea, JlaryI, UyzNg, rRc, NwKVKM, lvxjy, LZeEl, zPJ, TZIl, SHj, QNjkKQ, rvM, AXB, oDj, uwcck, mebeb, TpFd, OJaHFs, Xtt, RHc, JCc, TLfB, hyO, ZozN, lMKM, prms, ePmD, ASE, IFGP, MsbEH, jwJ, pRblH, QMVo, jfpU, YNEIO, xsKpcT, MigQN, tqbBm, KBBSwQ, noTi, iLELQy, zsUHFm, zBTJi, RawEET, ZWQb,

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