Chapman & Nakielny's Aids to Radiological Differential Diagnosis: Expert Consult - Online and Print

Chapman & Nakielny's Aids to Radiological Differential Diagnosis is a well-loved radiology resource, used by trainees and practitioners worldwide to hone their knowledge of radiological differential diagnosis for the most commonly encountered conditions throughout the body. It is an invaluable quick-reference companion in everyday practice, as well as an essential study tool when preparing for the FRCR or similar examinations. First published 35 years ago Stephen Chapman and Richard Nakielny's original aims remain as relevant today as when the book was originally conceived. 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. Comprehensive lists of differential diagnoses to aid effective diagnoses Closely aligned to the needs of current FRCR curriculum Brief, to the point text and clear page format allows for rapid access to key information. Part 2 of the book has been restructured to focus on multisystem disorders which cannot be fully covered in the individual chapters in Part 1. A new chapter on Nuclear Medicine has been added to reflect its importance in modern medical imaging. The chapter on head and neck conditions has been significantly expanded. Important discriminating features have been added to nearly every differential to aid the reader in developing a strategy for reaching a diagnosis. The top differentials in each list which are considered important for radiology trainees to learn for exams are underlined. -- Publisher Front Cover IFC_Expert Consult advert Chapman & Nakielny's Aids to Radiological Differential Diagnosis Copyright Page Table Of Contents Preface and explanatory notes List of Contributors Acknowledgements Abbreviations 1 1 Bones 1.1 Generalized increased bone density in an adult Most common Less common Rare 1.2 Solitary sclerotic bone lesion Most common Less common 1.3 Multiple sclerotic bone lesions Most common Less common Rare 1.4 Bone sclerosis with a periosteal reaction Most common Less common Rare 1.5 Solitary sclerotic bone lesion with a lucent centre Most common Less common Rare 1.6 Coarse trabecular pattern 1.7 Skeletal metastases Lytic Lytic and expansile Sclerotic Mixed 1.8 Sites of origin of common primary bone lesions 1.9 Common features of solitary intraosseous lesions 1.10 Lucent bone lesions Well-defined, sclerotic margin Well-defined, nonsclerotic margin Poorly defined margin 1.11 Grossly expansile lucent bone lesion Most common Less common Rare 1.12 Lucent epiphyseal bone lesion 1.13 Lucent bone lesion containing calcium or bone Most common Less common 1.14 Exophytic and juxtacortical bone lesions 1.15 ‘Moth-eaten bone’ in an adult 1.16 Regional osteopenia Most common Less common 1.17 Generalized osteopenia 1.18 Osteoporosis Radiographic findings Causes Primary Secondary 1.19 Osteomalacia and rickets Most common causes Other causes Conditions which mimic rickets/osteomalacia In infants 3 mm) Pericardial effusion Further reading 6.9 Cardiac masses Further reading 6.10 Late gadolinium enhancement on cardiac MRI Subendocardial or transmural LGE Subepicardial or midmyocardial LGE Further reading 6.11 Malignant coronary artery anomalies in the adult Further reading 6.12 Causes of a perfusion defect on cardiac stress perfusion MRI 6.13 Acute aortic syndromes Further reading 6.14 Thoracic aortic aneurysm Isolated sinus of Valsalva aneurysm Annuloaortic ectasia Ascending aortic aneurysm Descending aortic aneurysm Further reading 6.15 Increased aortic wall thickness Further reading 6.16 Focal narrowing of the aorta Further reading 6.17 Systemic disorders associated with nonaortic aneurysms Further reading 6.18 Intravascular lesions 6.19 Endoleak appearances on multiphasic CT following endovascular aneurysm repair Further reading 6.20 Pulmonary arterial enlargement Diffuse MPA enlargement (MPA > adjacent ascending aorta) Focal pulmonary artery aneurysm Further reading 6.21 Pulmonary hypertension Further reading 7 Abdomen and gastrointestinal tract 7.1 Pneumoperitoneum Causes Further reading 7.2 Gasless abdomen 7.3 Pharyngeal/oesophageal pouches and diverticula Upper third Middle third Lower third Mimics Further reading 7.4 Oesophageal ulceration Inflammatory Infective Iatrogenic Related to systemic diseases Neoplastic Further reading 7.5 Oesophageal mucosal nodularity 7.6 Oesophageal strictures—smooth Inflammatory Neoplastic submucosal and extrinsic masses Nonneoplastic submucosal and extrinsic masses Others Further reading 7.7 Oesophageal strictures—irregular Neoplastic Inflammatory Iatrogenic 7.8 Dilated oesophagus 7.9 Tertiary contractions in the oesophagus Further reading 7.10 Gastric masses and filling defects Malignant neoplasms Polyps Benign submucosal neoplasms Extrinsic indentation Others 7.11 Gastric fold thickening Inflammatory Infiltrative/neoplastic Others Further reading 7.12 Linitis plastica Neoplastic Inflammatory 7.13 Gastric or duodenal obstruction 7.14 Decreased/absent duodenal folds 7.15 Duodenal wall/fold thickening or mass Neoplastic Inflammatory Vascular Congenital/developmental Further reading 7.16 Dilated small bowel Normal folds Thick folds Further reading 7.17 Small bowel strictures 7.18 Small bowel masses Malignant Benign Further reading 7.19 Small bowel wall thickening Soft-tissue attenuation wall thickening Submucosal oedema with avid mucosal enhancement Submucosal oedema with normal mucosal enhancement Submucosal oedema with reduced mucosal enhancement 7.20 Ileocaecal region thickening Inflammatory Infective Neoplastic Ischaemia Further reading 7.21 Colitis on cross-sectional imaging Diffuse Predominantly right-sided Predominantly left-sided Predominantly rectal (proctitis) Further reading 7.22 Colonic polyps on CT colonography Polyp mimics 7.23 Colonic strictures and masses Neoplastic Inflammatory and ischaemic Infective Extrinsic masses 7.24 Megacolon in an adult Nontoxic (without mural abnormalities) Toxic (with severe mural abnormalities) 7.25 Pneumatosis intestinalis Benign causes (well patient) Life-threatening causes (unwell patient) Further reading 7.26 Bowel wall calcification 7.27 Bowel wall fat deposition 7.28 Rectal mass or thickening on MRI Malignant neoplasms Benign neoplasms Inflammatory and infective Others Further reading 7.29 Retrorectal/presacral mass Further reading 7.30 Anal and perianal masses Further reading 7.31 Mesenteric and omental fat stranding Focal Diffuse Further reading 7.32 Mesenteric lymphadenopathy Further reading 7.33 Peritoneal, omental or mesenteric mass Solid Neoplasms Fibroinflammatory and infiltrative processes Others Cystic Fat-containing Further reading 7.34 Peritoneal thickening Nodular or irregular Smooth 7.35 Abdominal wall mass Lesions arising from the skin Lesions containing fat Iatrogenic or traumatic lesions Cystic lesions Malignant neoplasms Benign neoplasms Other lesions Further reading 8 Hepatobiliary, pancreas and spleen 8.1 Intraluminal gallbladder lesions Further reading 8.2 Gallbladder wall thickening Diffuse Focal Further reading 8.3 Biliary dilatation Luminal causes (and nonobstructive dilatation) Mural causes (strictures) Extrinsic causes (arranged from distal to proximal) Further reading 8.4 Gas in the biliary tree Within the bile ducts Within the gallbladder 8.5 Gas in the portal veins Further reading 8.6 Hepatomegaly without discrete lesions Acute hepatitis Cardiovascular Neoplastic Infiltrative/depositional Storage disorders Myeloproliferative disorders Congenital Further reading 8.7 Hepatic calcification and increased density Small and punctate calcification Curvilinear calcification Calcification within a mass Diffusely increased density Focal increased density (noncalcified) Further reading 8.8 Diffusely hypoechoic liver 8.9 Diffusely hyperechoic liver 8.10 Diffusely heterogeneous liver Further reading 8.11 Focal hyperechoic liver lesion With posterior acoustic shadowing Nonshadowing 8.12 Focal hypoechoic liver lesion Further reading 8.13 Periportal hyperechogenicity 8.14 Periportal oedema Hepatic causes Extrahepatic causes Further reading 8.15 Periportal lesions Vascular Biliary Haematological/lymphatic Others Further reading 8.16 Cystic liver lesions Unilocular and thin-walled Multilocular or thick-walled Further reading 8.17 Fat-containing liver lesions Macroscopic fat Microscopic fat Further reading 8.18 Hypervascular liver lesions Arterial enhancement persisting on the delayed phase Arterial enhancement equilibrating on the delayed phase Arterial enhancement with washout on portal or delayed phase Rare hypervascular tumours with nonspecific appearances Further reading 8.19 Liver lesions with gradual delayed enhancement Further reading 8.20 Hypovascular liver lesions Further reading 8.21 Liver lesions with a central scar Further reading 8.22 Hepatic capsular retraction Further reading 8.23 T1 hyperintense liver lesions Further reading 8.24 T2 hypointense liver lesions Further reading 8.25 Lesions in chronic liver disease Further reading 8.26 Flowchart for characterizing liver lesions on MRI 8.27 Hepatocyte-specific MR contrast agents Further reading 8.28 Splenomegaly Huge spleen Moderately large spleen Slightly large spleen 8.29 Splenic calcification Curvilinear Multiple small nodular/punctate Diffuse homogeneous Solitary >1 cm 8.30 Cystic splenic lesions 8.31 Solid splenic lesions Nonneoplastic Benign neoplasms and hamartomas Malignant neoplasms Further reading 8.32 Pancreatic calcification Further reading 8.33 Pancreatic duct dilatation 8.34 Cystic pancreatic lesions Further reading 8.35 Solid pancreatic lesions Hypovascular Hypervascular Further reading 9 Adrenals, urinary tract, testes and prostate 9.1 Incidental adrenal mass (unilateral) Functioning tumours Malignant tumours Benign Further reading 9.2 Bilateral adrenal masses Further reading 9.3 Adrenal calcification Further reading 9.4 Congenital renal anomalies Anomalies of position Anomalies of form Anomalies of number Further reading 9.5 Localized bulge of the renal outline on ivu Further reading 9.6 Unilateral scarred kidney Differential diagnosis 9.7 Unilateral small smooth kidney Prerenal = vascular Renal = parenchymal Postrenal = collecting system 9.8 Bilateral small smooth kidneys Prerenal = vascular Renal = parenchymal Postrenal = collecting system 9.9 Unilateral large smooth kidney Prerenal = vascular Renal = parenchymal Postrenal = collecting system Further reading 9.10 Bilateral large smooth kidneys Developmental Inflammation/oedema Deposition of abnormal proteins Neoplastic infiltration Miscellaneous Further reading 9.11 Renal calcification Dystrophic calcification due to localized disease Further reading 9.12 Renal calculi Calcium-containing Pure calcium oxalate Struvite Cystine Uric acid Xanthine Stones radiolucent on CT (soft-tissue attenuation) Further reading 9.13 Mimics of renal colic on unenhanced CT urography Nonstone genitourinary Gynaecological Gastrointestinal Pancreatic and hepatobiliary disorders Vascular Musculoskeletal Further reading 9.14 Nephrocalcinosis Medullary (pyramidal) Cortical Further reading 9.15 Renal cystic disease Renal dysplasia Polycystic kidney disease* Cystic tumours Cortical cysts Medullary cysts Miscellaneous Extraparenchymal renal cysts Further reading 9.16 Bosniak classification of renal cysts Bosniak I—simple cyst Bosniak II—minimally complicated Bosniak IIF—minimally complicated requiring follow-up Bosniak III—measurable enhancement/probably malignant Bosniak IV—clearly malignant Further reading 9.17 Fat-containing renal mass Further reading 9.18 Solid renal lesions Well-defined mass Infiltrative lesions Further reading 9.19 Renal sinus mass Neoplastic Nonneoplastic lesions Further reading 9.20 Neoplastic and proliferative disorders of the perinephric space Soft-tissue rind Focal solid lesions Fatty lesions Cystic lesions Further reading 9.21 Nephrographic patterns Absent nephrogram Unilateral delayed nephrogram Bilateral persistent nephrogram Unilateral striated nephrogram Bilateral striated nephrogram Spotted nephrogram Reverse rim nephrogram Further reading 9.22 Diffuse low signal in the renal cortex on MRI Further reading 9.23 Renal papillary necrosis Further reading 9.24 Renal causes of hypertension 9.25 Renal artery stenosis Aetiology Further reading 9.26 Nonopacification of a calyx on CT or excretory urography Further reading 9.27 Filling defect in the renal collecting system or ureter Extrinsic with a smooth margin Arising from the wall with smooth margins Arising from the wall with an irregular margin In the lumen Further reading 9.28 Spontaneous urinary contrast extravasation Further reading 9.29 Collecting system dilatation Dilated calyx with a narrow infundibulum/renal pelvis Dilated calyx with a wide infundibulum and normal renal pelvis Dilated renal pelvis with normal calyces Dilated calyces and renal pelvis with a normal ureter Dilated pelvicalyceal system and ureter 9.30 Dilated ureter Obstruction Within the lumen In the wall Outside the wall Vesicoureteric reflux No obstruction or reflux Further reading 9.31 Deviated ureters Medial deviation Lateral deviation 9.32 Retroperitoneal mass Solid Cystic Fat containing Further reading 9.33 Retroperitoneal fibrosis Aetiology Further reading 9.34 Filling defect or mass in the bladder Within the lumen Arising from the wall Extrinsic Further reading 9.35 Diffuse bladder wall thickening Inflammatory Muscular hypertrophy Neoplastic Further reading 9.36 Bladder calcification In the lumen In the wall Further reading 9.37 Bladder fistula Congenital Inflammatory Neoplastic Trauma Further reading 9.38 Gas in the urinary system Gas in the bladder lumen Gas in the bladder wall Gas in the ureters and pelvicalyceal systems Further reading 9.39 Urachal lesions Further reading 9.40 Calcifications of the male genital tract Seminal vesicles and vas deferens Prostate Scrotum Penis Further reading 9.41 Prostatic lesions Solid Cystic Further reading 9.42 Seminal vesicle abnormalities Further reading 9.43 Ultrasound of intratesticular abnormalities Neoplastic Nonneoplastic cysts Vascular Infective Miscellaneous Further reading 9.44 Ultrasound of extratesticular abnormalities Within epididymis Paratesticular Related to spermatic cord Further reading 9.45 Male urethral stricture Further reading 10 Gynaecology and obstetrics Gynaecological imaging 10.1 common indications for gynaecological ultrasound Primary amenorrhoea Secondary amenorrhoea Postmenopausal bleeding (PMB) Acute pelvic pain Chronic pelvic pain Raised Ca-125 (normal 5 cm) well-defined mammographic abnormality 11.7 Benign conditions that mimic malignancy 11.8 Oedematous breast Causes without erythema/inflammation Causes with erythema/inflammation 11.9 Architectural distortion on mammography without a visible mass 11.10 Shrunken breast 11.11 Duct dilatation Benign Malignant 11.12 Axillary lymphadenopathy 11.13 Male breast disease 11.14 MRI in breast disease Indications Enhancement patterns 11.15 Breast augmentation Types of breast augmentation Normal imaging appearances of breast implants Complications of breast implants Further reading 12 Head and neck 12.1 Parapharyngeal space lesions 12.2 Pharyngeal mucosal space lesions: nasopharynx 12.3 Pharyngeal mucosal space lesions: oropharynx 12.4 Masticator space lesions 12.5 Focal parotid space lesions 12.6 Diffuse parotid enlargement 12.7 Carotid space lesions 12.8 Perivertebral space lesions 12.9 Posterior cervical space lesions 12.10 Retropharyngeal space lesions: focal 12.11 Retropharyngeal space lesions: diffuse 12.12 Oral cavity: oral mucosal space lesions 12.13 Oral cavity: sublingual space lesions 12.14 Oral cavity: submandibular space lesions 12.15 Oral cavity: root of tongue lesions 12.16 Transspatial neck lesions 12.17 Visceral space lesions Laryngeal lesions Other lesions 12.18 Thyroid enlargement 12.19 British thyroid association ultrasound grading Features associated with benign nodules Features associated with malignant nodules Features associated with follicular lesions 12.20 Sonographic features of normal versus abnormal lymph nodes 12.21 Bony lesions of mandible/ maxilla: cystic 12.22 Bony lesions of mandible/ maxilla: solid Lytic Sclerotic, calcified or ossified Unrelated to the teeth Related to the teeth Ground-glass, mixed or variable density Unrelated to the teeth Related to the teeth 12.23 Nasal septal perforation 12.24 Paranasal sinus lesion without bone destruction Inflammatory Neoplastic 12.25 Paranasal sinus lesion with bone destruction 12.26 Orbit: lesions involving the globe 12.27 Orbit: lesions of the optic nerve or sheath 12.28 Orbit: lesions arising within intraconal fat 12.29 Orbit: conal lesions 12.30 Orbit: extraconal lesions Lesions arising within the orbital cavity Lesions arising from the orbital wall 12.31 External auditory canal lesions 12.32 Middle ear lesions 12.33 Petrous apex lesions Normal variants Well-defined and expansile + bone remodelling Destructive Other 12.34 Diffuse or multifocal skull base lesions 12.35 Unifocal skull base lesion 12.36 Clivus lesions 12.37 Jugular foramen lesions Further reading 13 Skull and brain 13.1 Solitary acute intracranial haemorrhage 13.2 Subarachnoid haemorrhage (SAH) 13.3 Multifocal acute intracerebral haemorrhage 13.4 Microhaemorrhages on MRI Further reading 13.5 Superficial siderosis Classical Cortical Mimics of superficial siderosis Further reading 13.6 Hydrocephalus CSF overproduction Communicating Obstructive Any level Foramen of Monro Cerebral aqueduct Fourth ventricle 13.7 Intracranial calcification Physiological Deep grey matter Ependymal/periventricular Gyriform Focal lesions with calcification Further reading 13.8 Solitary intracerebral mass Infiltrative, ill–defined Discrete, well-defined Further reading 13.9 Solitary hyperdense intracranial lesion on unenhanced CT Hypercellular mass Lesion containing blood/protein Lesion containing calcification Further reading 13.10 Intrinsic cortical mass 13.11 Posterior fossa mass (adult) Further reading 13.12 Solitary ring-enhancing lesion Infection Neoplastic Inflammatory Vascular/trauma 13.13 Multiple ring-enhancing lesions Neoplastic Infection Inflammatory Vascular/trauma Further reading 13.14 Intracranial cyst with mural nodule Neoplastic Infection 13.15 Enhancing lesions in perivascular spaces Further reading 13.16 Meningeal enhancement Pachymeningeal (dura–arachnoid) Leptomeningeal (pia–arachnoid) Further reading 13.17 Ependymal enhancement 13.18 Cranial nerve (CN) enhancement Rules: Neoplastic Infection Inflammatory Granulomatous Other Further reading 13.19 Enlarged leptomeningeal perforators 13.20 WM lesions with little mass effect Punctate lesions Confluent WM lesions (up to 20 mm in size) Diffuse WM lesions (spanning ≥2 cerebral lobes) Further reading 13.21 Corpus callosum (CC) lesions Atrophic/dysplastic callosum Multifocal lesions Neoplasms Transient lesions Hydrocephalus-related 13.22 Deep grey matter abnormalities Physiological Vascular Neurodegenerative Toxins Acquired metabolic disease Inherited metabolic disease Infectious Further reading 13.23 Basal ganglia: bright on t1 Paramagnetic substances Unknown cause Further reading 13.24 Symmetrical basal ganglia susceptibility changes Calcium Iron Further reading 13.25 Bilateral thalamic lesions Vascular Infection Metabolic Neoplastic 13.26 Bilateral middle cerebellar peduncle (mcp) lesions Degenerative (~40%) Metabolic/toxic (~20%) Cerebrovascular (~15%) Infection/Inflammatory (~15%) Neoplastic (~10%) Further reading 13.27 Intrasellar mass Approach to sellar lesions Intrinsic to the gland Extrinsic to the gland Further reading 13.28 Pituitary infundibular lesion Neoplastic Nonneoplastic Further reading 13.29 Suprasellar mass Meningeal Vascular Parenchymal Optic chiasm Cisternal 13.30 Cavernous sinus (CS)/ parasellar mass Extension from pituitary lesion Dural Cavernous sinus metastases Neurogenic Vascular Skull base 13.31 Optic nerve abnormal signal 13.32 Pineal region mass Pineal gland Cystic Posterior brainstem Vascular lesions Other Further reading 13.33 Intraventricular mass in adults Choroid plexus lesion Tumours of the ventricular wall Nonchoroid cyst-like lesions Others Further reading 13.34 Cerebellopontine angle mass 13.35 Cortical hyperintensity on t2/FLAIR 13.36 Sulcal FLAIR hyperintensities Changes to CSF content Meningeal Vascular Artefactual/Iatrogenic 13.37 Causes of high t1 signal Further reading 13.38 Causes of low t2 signal Further reading 13.39 Causes of restricted diffusion Cortical/subcortical Focal lesion 13.40 Fat-containing intracranial lesions 13.41 Cyst-like posterior fossa lesions 13.42 Cerebral volume loss Generalized Focal Regional pattern Further reading 13.43 Cerebellar volume loss 13.44 Brainstem atrophy Diffuse Regional 13.45 Skull vault lucency without sclerotic edge Normal Neoplastic (adults) Neoplastic (children) Traumatic Metabolic Infective Vascular Others 13.46 Skull vault lucency with sclerotic edge Normal Developmental Neoplastic Infective Others 13.47 Generalized increase in skull vault density 13.48 Localized increase in skull vault density Within bone Adjacent to bone 13.49 Thickened skull Generalized Focal 13.50 Thin skull Generalized Focal 13.51 ‘Hair-on-end’ skull vault Haemolytic anaemias Other causes of red marrow hyperplasia Neoplastic 13.52 Platybasia and basilar invagination/impression Congenital Acquired 13.53 J-shaped sella 13.54 Scalp mass Skin Subcutaneous tissue Subgaleal plane Bone lesions 14 Paediatrics 14.1 Retarded skeletal maturation Chronic ill-health Endocrine disorders Congenital disorders 14.2 Generalized accelerated skeletal maturation Endocrine disorders Congenital disorders Others Further reading 14.3 Premature closure of a growth plate Further reading 14.4 Asymmetrical maturation Hemihypertrophy or localized gigantism Hemiatrophy or localized atrophy Further reading 14.5 Skeletal dysplasias With predominant metaphyseal involvement With predominant epiphyseal involvement Mesomelic dysplasias (short forearms ± shanks) Acromelic dysplasias (short hands and feet) Dysplasias with major involvement of the spine 14.6 Lethal neonatal dysplasia Further reading 14.7 Conditions exhibiting dysostosis multiplex Further reading 14.8 Generalized increased bone density Dysplasias Metabolic Poisoning Idiopathic Further reading 14.9 Paediatric tumours that metastasize to bone 14.10 ‘Moth-eaten bone’ in a child Neoplastic Infective Further reading 14.11 Periosteal reactions—bilaterally symmetrical in children 14.12 Syndromes and bone dysplasias featuring multiple fractures With reduced bone