MANUAL OF RADIOLOGY: ACUTE PROBLEMS AND ESSENTIAL PROCEDURES Second Edition MANUAL OF RADIOLOGY: ACUTE PROBLEMS AND ESSENTIAL PROCEDURES Second Edition Edited by Clifford R. Weiss, MD Fellow, Vascular and Interventional Radiology The Russell H. Morgan Department of Radiology and Radiological Science The Johns Hopkins University School of Medicine Baltimore, Maryland Oleg M. Teytelboym, MD Resident/Fellow, Nuclear Medicine The Russell H. Morgan Department of Radiology and Radiological Science The Johns Hopkins University School of Medicine Baltimore, Maryland Nafi Aygun, MD Assistant Professor of Radiology The Russell H. Morgan Department of Radiology and Radiological Science The Johns Hopkins Medical Institution Baltimore, Maryland John Eng, MD Associate Professor of Radiology Joint Appointment in Health Sciences Informatics The Russell H. Morgan Department of Radiology and Radiological Science The Johns Hopkins University School of Medicine Baltimore, Maryland Acquisitions Editor: Lisa McAllister Managing Editor: Kerry Barrett Project Manager: Jennifer Harper Marketing Manager: Angela Panetta Senior Manufacturing Manager: Benjamin Rivera Art Director: Risa Clow Production Services: Laserwords Private Limited, Chennai, India © 2008 by LIPPINCOTT WILLIAMS & WILKINS, a Wolters Kluwer business 530 Walnut Street Philadelphia, PA 19106 USA LWW.com First edition, © 1997 by Lippincott-Raven Publishers All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in the USA Library of Congress Cataloging-in-Publication Data Manual of radiology / Clifford R. Weiss ... [et al.].—2nd. ed. p. ; cm. Includes bibliographical references and index. ISBN 978-0-7817-9964-5 1. Radiology, Medical—Handbooks, manuals, etc. I. Weiss, Clifford R. [DNLM: 1. Radiography—methods—Handbooks. WN 39 M295 2008] RC78.M242 2008 616.07 57—dc22 2007041348 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm, EST. 10987654321 CONTRIBUTORS Laura Amodei, MD Ari M. Blitz, MD Director of MRI Assistant Professor of Radiology Charleston Breast Center The Russell H. Morgan Department of Charleston, South Carolina Radiology and Radiological Science Johns Hopkins University School of Medicine Nafi Aygun, MD Baltimore, Maryland Assistant Professor of Radiology The Russell H. Morgan Department of Radiology and Radiological Paul D. Campbell, Jr. Science Resident, Diagnostic Radiology The Johns Hopkins University School of The Russell H. Morgan Department of Medicine Radiology and Radiological Science Baltimore, Maryland Johns Hopkins University School of Medicine Baltimore, Maryland Brad P. Barnett Medical Student Claire S. Cooney, MD The Johns Hopkins University School of Fellow, Body Imaging Medicine The Russell H. Morgan Department of Baltimore, Maryland Radiology and Radiological Science Johns Hopkins University School of Visveshwar Baskaran, MD Medicine Chief Resident, Diagnostic Radiology Baltimore, Maryland The Russell H. Morgan Department of Radiology and Radiological Azar P. Dagher, MD Science Annapolis Radiology Associates Johns Hopkins University School of Anne Arundel Medical Center Medicine Annapolis, Maryland Baltimore, Maryland Mandeep Dagli, MD Fellow, Vascular and Interventional Norman J. Beauchamp, Jr., MD, MHS Radiology Professor and Chair The Russell H. Morgan Department of Department of Radiology Radiology and Radiological Science University of Washington Johns Hopkins University School of Seattle, Washington Medicine Baltimore, Maryland Simon Bekker, MD Resident, Diagnostic Radiology Michael W. D’Angelo, MD, MS The Russell H. Morgan Department Fellow, Muskuloskeletal Imaging of Radiology and Radiological The Russell H. Morgan Department of Science Radiology and Radiological Science Johns Hopkins University School of Johns Hopkins University School of Medicine Medicine Baltimore, Maryland Baltimore, Maryland v vi Contributors Joseph P. DiPietro, MD Edward H. Herskovits, MD, PhD Resident, Diagnostic Radiology Associate Professor The Russell H. Morgan Department of Department of Radiology Radiology and Radiological Science University of Pennsylvania Johns Hopkins University School of Philadelphia, Pennsylvania Medicine Baltimore, Maryland Andrew L. Holz, MD, MBA Resident Fellow, Nuclear Medicine W. Dee Dockery, MD The Russell H. Morgan Department Partner, American Radiology Associates, of Radiology and Radiological P. A. Science Dallas, Texas Johns Hopkins University School of Medicine Baltimore, Maryland Daniel J. Durand, MD Resident, Diagnostic Radiology The Russell H. Morgan Department of Karen M. Horton, MD Radiology and Radiological Science Associate Professor of Radiology Johns Hopkins University School of The Russell H. Morgan Department Medicine of Radiology and Radiological Baltimore, Maryland Science Johns Hopkins University School of Medicine Timothy S. Eckel, MS, MD Baltimore, Maryland Director, Diagnostic and Interventional Neuroradiology Annapolis Radiology Associates Krishna Juluru, MD Anne Arundel Medical Center Assistant Professor Annapolis, Maryland Department of Radiology Weill Medical College of Cornell University New York, New York John Eng, MD Associate Professor of Radiology Joint Appointment in Health Sciences Satomi Kawamoto, MD Informatics Assistant Professor of Radiology The Russell H. Morgan Department of The Russell H. Morgan Department Radiology and Radiological Science of Radiology and Radiological Johns Hopkins University School of Science Medicine Johns Hopkins University School of Baltimore, Maryland Medicine Baltimore, Maryland Bradley R. Foerster, MD Fellow, Neuroradiology Alexander M. Kowal, MD The Russell H. Morgan Department of Resident, Diagnostic Radiology Radiology and Radiological Science The Russell H. Morgan Department Johns Hopkins University School of of Radiology and Radiological Medicine Science Baltimore, Maryland Johns Hopkins University School of Medicine Baltimore, Maryland David J. Grelotti, MD Clinical Fellow Department of Psychiatry George P. Kuo, MD Harvard Medical School; Resident, Diagnostic Radiology Resident in Psychiatry The Russell H. Morgan Department of Department of Psychiatry Radiology and Radiological Science Massachusetts General Hospital and Johns Hopkins University School of McLean Hospital Medicine Boston, Massachusetts Baltimore, Maryland Contributors vii Loralie D. Ma, MD Myria Petrou, MD Clinical Asst. Professor of Radiology Fellow, Neuroradiology Department of Radiology The Russell H. Morgan Department of The Johns Hopkins Hospital; Radiology and Radiological Science Medical Director The Johns Hopkins University School of Department of Radiology Medicine Greater Baltimore Medical Center Baltimore, Maryland Baltimore, Maryland Valerie A. Pomper, MD Aimee Lynn Maceda, MD Staff Radiologist Fellow, Body Imaging Department of Radiology The Russell H. Morgan Department of Washington Adventist Hospital Radiology and Radiological Science Takoma Park, Maryland Johns Hopkins University School of Medicine Baltimore, Maryland Douglas E. Ramsey, MD Radiology Resident Cathleen F. Magill, MD Russell H. Morgan Department of Chief Resident Radiology and Radiological Sciences Department of Internal Medicine The Johns Hopkins University School of The Johns Hopkins University Medicine Chief Resident Baltimore, Maryland Department of Internal Medicine The Johns Hopkins Bayview Medical Center Hari Charan P. Reddy, MD Baltimore, Maryland Fellow,