Medical Radiology Diagnostic Imaging Series Editors Albert L. Reiser Hedvig Hricak Michael Knauth Editorial Board Andy Adam, London Fred Avni, Brussels Richard L. Baron, Chicago Carlo Bartolozzi, Pisa George S. Mark Davies, Birmingham William P.
Dillon, San Francisco D. David Dershaw, New York Sam Sanjiv Gambhir, Stanford Nicolas Grenier, Bordeaux Gertraud Heinz-Peer, Vienna Robert Hermans, Leuven Hans-Ulrich Kauczor, Heidelberg Theresa McLoud, Boston Konstantin Nikolaou, Munich Caroline Reinhold, Montreal Donald Resnick, San Diego Rüdiger Schulz-Wendtland, Erlangen Stephen Solomon, New York Richard D. White, Columbus For further volumes: http://www.com/series/4354 This page intentionally left blank Mariano Scaglione • Ulrich Linsenmaier Gerd Schueller Editors Emergency Radiology of the Abdomen Imaging Features and Differential Diagnosis for a Timely Management Approach 123 Mariano Scaglione Prof. Gerd Schueller, MBA Department of Diagnostic Imaging Department of Radiology Pineta Grande Medical Center Medical University of Vienna Castel Volturno General Hospital of Vienna Italy Vienna Austria Ulrich Linsenmaier Department of Clinical Radiology Ludwig-Maximilians-University Munich Germany and Director Institute of Diagnostic Radiology and Interventional Therapy Klinikum München Pasing & Perlach (KMPP) Munich Germany ISSN 0942-5373 ISBN 978-88-470-2512-7 e-ISBN 978-88-470-2513-4 DOI 10.1007/978-88-470-2513-4 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2012932402 Ó Springer-Verlag Berlin Heidelberg 2012 This work is subject to copyright.
All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, 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 protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.com) To my beloved sons, Pietro e Ruben, for their love, encourage and support Mariano Scaglione My thanks go to my family, my beloved children Laura and Lukas, my brother Jörg and all friends for supporting me and encouraging my scientific work Ulrich Linsenmaier For Claudia, my wife, whose constant support is a great asset in my life: and to my daughters Nadja, Mona, and Linda, who tried but eventually did not preclude the writing of this book Gerd Schueller This page intentionally left blank Foreword Emergency Radiology of the Abdomen Imaging Features and Differential Diagnosis for a Timely Management Approach Things may at the same time become more difficult and easier.
This very general remark also applies to the topic of this book ‘‘Emergency Radiology of the Abdomen’’. On one hand state-of-the-art imaging technologies allow for a straight forward diagnosis in many cases of acute abdomen, trauma to the abdomen and other emergency conditions related to diseases of abdominal organs. On the other hand, radiologists have to be more and more aware of clinical entities and pathological conditions in order to fulfil their duty, namely to provide our clinical partners with practically useful information. It is not so long ago, that surgeons had to perform laparotomy in order to make a definite diagnosis in cases of ambiguous clinical findings concerning the status of the abdominal organs.
Nowadays, imaging has become so precise and reliable, that in almost all cases a definitive diagnosis can be established before patients undergo surgery or in order to prevent unnecessary surgical procedures. Since we talk about potentially life threatening disorders and diseases, the diagnostic imaging is a critical issue. Therefore, radiologists have to be aware of the clinical needs, the great variability of disorders, which may only be cate- gorized correctly in view of the clinical history and clinical findings. Conse- quently, close cooperation and common understanding with emergency physicians are indispensable.
I would like to thank the editors of this edition of Medical Radiology/ Diagnostic Imaging for their initiative and for bringing together experts in the field. Considering the steadily increasing importance of diagnostic imaging in the management of patients with acute symptoms of the abdomen, this work may become an indispensible guide for many radiologists and clinicians. I would also like to thank all authors of the various chapters of this edition for their contribution and for the willingness to share their expertise with the readers of this book. Maximilian Reiser Department of Clinical Radiology University Hospitals Ludwig-Maximilians-University of Munich vii This page intentionally left blank Foreword Over the last 25 years Emergency Radiology has evolved into a specialty of Diagnostic Imaging.
Several major Emergency Radiology societies have arisen in many countries, there are now specialty journals on the subject, and many radiology departments throughout the world now have dedicated sections of Emergency Radiology often providing full-time coverage to their institutions. Of course, there has been and continues to be a need to organize this distinctive body of knowledge, which has grown so rapidly, and to educate the radiology community at large on this subject. Fortunately, diagnostic imaging technology has advanced over the last two decades to make the rapid and accurate diag- nosis of emergent pathology practical. The evolution of multi-row detector CT has, in the most urgent clinical scenarios, provided a near perfect diagnostic modality.
In this text, the emphasis is on emergent imaging in the abdomen. The origin of the word abdomen is not known with certainly. It is possibly derived from the Latin abdere meaning to hide, thus it might mean a cavity in which odds and ends are hidden away. This definition alludes to the fact that knowing what’s in abdomen and retroperitoneum, as regards acute pathology, is quite difficult making accurate diagnosis of pathology highly challenging.
Given that failure to identify and quickly treat life-threatening pathology can permit a patient’s death and unnecessarily opening the abdomen surgically to directly see what’s inside can lead to morbidity and occasionally mortality. The value of imaging to reveal ‘‘truth without intervention’’ has been of inestimable value. I have known Editors Uli Linsenmaier, MD and Dr. Mariano Scaglione, MD for many years and I know they bring a wealth of experience and knowledge to their subject.
You will find this text comprehensive, current, well- written, well illustrated, and reflective of their personal insights and opinions concerning complex and controversial issues relevant to the topic. You may note some variation between the U. and European perspective in the early diagnostic approach to assessing emergent abdominal conditions with a stronger emphasis on sonography in initial imaging in Europe, but less so in the U. with greater reliance on immediate CT.
They deal with the challenging issue of when to bypass imaging in favor of immediate surgery and how to integrate information obtained from the bedside and lab with imaging data in deciding optimal management. Controversies concerning the most appropriate ix x Foreword use of diagnostic imaging are elaborated upon and personal opinions supported. This book will be a standard for trainees and those needing to both refresh their knowledge of the subject and stay current in the field and will be a ref- erence source to resolve ‘‘at the moment’’ diagnostic uncertainty when time for ‘‘quiet reflection’’ is not available. The information contained herein is very ‘‘digestible’’, that is, easy to assimilate.
I fully expect that it will help you resolve many problematical acute abdominal imaging cases. Mirvis Professor and Director Section of Emergency Radiology University of Maryland School of Medicine Preface We, as radiologists, face a time in which rapid emergency radiology (ER) diagnosis and intervention are mandatory for the proper management of seri- ous abdominal emergencies. Indeed, the demand for diagnostic imaging in ER departments has risen dramatically over the last decade, with an exponential increase in the use of multi-detector computed tomography (MDCT) of up to 25% per year. In the USA, between 1996 and 2007, MDCT use during ER department visits grew by 330%, with the largest increase in older patients and for the diagnosis of abdominal or chest pain.
These rates are a direct result of the technical and methodological improvements in the use of MDCT. More- over, diagnostic imaging has, at least in part, virtually replaced physical examination for many emergency patients. Particularly in severely injured or critically ill patients referred to an emergency unit, immediate cross-sectional imaging is used as an adjunct to the primary patient survey (ATLS) and has proven to be of substantial benefit in establishing an adequate, timely, and individual therapy. In order to achieve excellent professional co-operation with referring phy- sicians, it is indispensable that radiologists have a concise understanding of the specific pathologies that are seen in the emergency setting, including appro- priate clinical knowledge of acute abdominal disorders.
Our aim in writing this book was to provide a comprehensive review of the traumatic as well as the non-traumatic emergency scenarios of the acute abdomen. The style of the presentation reflects the belief that improved time- lines and greater accuracy in diagnostic and interventional imaging lead to improved clinical management and better patient outcomes. Thus, the book focuses on the imaging features that are relevant to a timely management approach. It is a pleasure for us to offer this book to an international readership, with the support of the new European Society of Emergency Radiology (ESER), which was founded as a subspecialty society under the auspices of the European Society of Radiology (ESR).
In our opinion, emergency radiology requires comprehensive specialized training, consistent with the shift in radiologic education from a modality-based approach to organ—and process-specific practices. Dedicated abdominal emergency radiology training is a remarkable endeavor—one that not only has become an integral part of the core curriculum for residents and fellows but which is also very much in demand in postgraduate training. xi xii Preface We truly believe that this book could help fulfilling the unique demands of modern emergency radiology. Mariano Scaglione, MD Ulrich Linsenmaier, MD Gerd Schueller, MD, MBA Contents Acute Abdomen: Clinical Context and Indications for Imaging.
Khalil Acute Abdomen: Rational Use of us, MDCT, and MRI. 17 Vittorio Miele, Antonio Pinto, and Antonio Rotondo Liver and Bile Ducts. 31 Gerd Schueller Gallbladder. Berger, and Patrick M.
Geyer and Ulrich Linsenmaier Kidney, Ureter, Adrenal Gland. Scherr and Ulrich Linsenmaier Gastrointestinal Tract. 133 Mariano Scaglione, Veronica Di Mizio, Antonio Pinto, Maria Antonietta Mazzei, Luigia Romano, and Roberto Grassi The Pelvis. 165 Lorenzo Mannelli, Claudia T.
Dighe, and Joel A. Gross Vascular Emergencies of the Retroperitoneum. 189 Gianpaolo Carrafiello, Monica Mangini, Anna M. Ierardi, Chiara Recaldini, Elisa Cotta, Filippo Piacentino, and Carlo Fugazzola MRI of the Acute Abdomen and Pelvis.
207 Garry Choy, Ajay K. Singh, and Robert A. Novelline xiii xiv Contents Imaging the Acute Abdomen Within the Pediatric Population. Avni, Nasroolla Damry, and Marie Cassart The Role of Interventional Radiology.
235 Stefan Wirth and Marcus Treitl Index. Avni Department of Radiology, Erasme Hospital, Brussels, Belgium, e-mail: Freddy. Berger Department of Radiology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands Gianpaolo Carrafiello Department of Radiology, University of Insubria, Varese, Italy, e-mail: gcarraf@gmail. Cassart Department of Radiology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria Garry Choy Department of Radiology, Division of Emergency Radiology and Teleradiology, Massachusetts General Hospital, Boston, MA, USA, e-mail: gchoy@partners.
Cotta Department of Radiology, University of Insubria, Varese, Italy N. Damry Pediatric Imaging, Children’s Hospital Queen Fabiola, Brussels, Belgium V. Di Mizio Radiology Service, Santa Maria della Misericordia Hospital, Rovigo, Italy M. Dighe Department of Radiology, University of Washington, Seattle, WA, USA C.
Fugazzola Department of Radiology, University of Insubria, Varese, Italy L. Geyer Department of Clinical Radiology, University Hospital LMU Munich, Munich, Germany, e-mail: lucas.