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Access to the eBook is limited to the first individual who redeems the PIN, located on the inside cover of this book, at expertconsult.inkling.com and may not be transferred to another party by resale, lending, or other means. CHEST RADIOLOGY Patterns and Differential Diagnoses This page intentionally left blank Seventh Edition CHEST RADIOLOGY Patterns and Differential Diagnoses James C. Reed, MD Professor of Radiology University of Louisville Louisville, Kentucky 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 CHEST RADIOLOGY: PATTERNS AND DIFFERENTIAL DIAGNOSES ISBN: 978-0-323-49831-9 SEVENTH EDITION Copyright © 2018 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the Publisher. Details on how to seek permis- sion, further information about the Publisher’s permissions policies, and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and expe- rience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods, they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to deter- mine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence, or otherwise or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2011, 2003, 1997, 1991, 1987, 1981 by Mosby, Inc., an affiliate of Elsevier Inc. Library of Congress Cataloging-in-Publication Data Names: Reed, James C. (James Croft), 1942- author. Title: Chest radiology : patterns and differential diagnoses / James C. Reed. Description: Seventh edition. | Philadelphia, PA : Elsevier, [2018] | Previous editions have subtitle: Plain film patterns and differential diagnoses. | Includes bibliographical references and index. Identifiers: LCCN 2017043419 | ISBN 9780323498319 (hardcover : alk. paper) Subjects: | MESH: Radiography, Thoracic | Diagnosis, Differential | Respiratory Tract Diseases--diagnostic imaging Classification: LCC RC941 | NLM WF 975 | DDC 617.5/40757--dc23 LC record available at https://lccn.loc.gov/2017043419 Executive Content Strategist: Robin Carter Senior Content Development Specialist: Rae Robertson Publishing Services Manager: Catherine Albright Jackson Senior Project Manager: Doug Turner Designer: Maggie Reid Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Thank you to my wife, Sharon, for the support and encouragement that have made it possible for this text to reach a seventh edition. This edition is dedicated to our grandchildren: Samantha, Hailey, Zachary, James III, Morgan, Connor, Madeline, and Andrew v This page intentionally left blank PREFACE Chest radiology is sometimes considered to be the static part of a radiology practice, but chest radiology has shared the benefits of the imaging revolution. The chest x-ray contains a lot of information that is compressed into one or two images compared with several hundred images in a complete chest computed tomography (CT) examination with axial, coronal, and sagittal images. Chest CT provides a better understanding of chest disease and has become an important part of chest radiology. CT has added new descriptive patterns to our lexicon, including ground glass opacities, ground glass nod- ules, mosaic perfusion, and crazy paving. Special CT protocols such as high-resolution CT and CT angiography have given us the ability to make more specific diagnoses. The impact of magnetic resonance imaging and ultrasound are more limited because of the air in the lungs, but they also have important thoracic applications. Continued medical progress and our collaborations with colleagues in medicine, surgery, and pathology have enhanced our understanding of chest diseases. By com- bining our new understanding of tumor biology with technical advancements, new imaging strategies such as low-dose CT screening for lung cancer have been developed. Over the course of seven editions of this text there have been many changes in chest radiology, but a patient with chest symptoms still almost always has a chest x-ray as a first examination. Evaluation of the chest x-ray continues to require accurate percep- tion of the abnormalities, recognition of the basic patterns, and development of a working differential diagnosis. James C. Reed, MD vii ACKNOWLEDGMENTS A special thank you to Mr. Danny McGrath for assistance with production of the new digital illustrations and Ms. Lisa Floore for technical assistance and advice on manu- script preparation. James C. Reed, MD viii CONTENTS PART 1 Chest Wall, Pleura, and Mediastinum 1 INTRODUCTION, 2 2 CHEST WALL LESIONS, 5 Questions, 6 Discussion, 7 Top 5 Diagnoses: Chest Wall Lesions, 19 Summary, 19 Answer Guide, 19 3 PLEURAL AND SUBPLEURAL OPACITIES, 21 Questions, 23 Discussion, 24 Top 5 Diagnoses: Pleural and Subpleural Opacities, 34 Summary, 34 Answer Guide, 35 4 PLEURAL EFFUSIONS, 36 Questions, 38 Discussion, 40 Top 5 Diagnoses: Pleural Effusions, 50 Summary, 50 Answer Guide, 51 5 PLEURAL THICKENING AND PLEURAL CALCIFICATION, 52 Questions, 53 Discussion, 54 Top 5 Diagnoses: Pleural Thickening and Pleural Calcification, 62 Summary, 62 Answer Guide, 62 6 ELEVATED DIAPHRAGM, 63 Questions, 63 Discussion, 64 Top 5 Diagnoses: Elevated Diaphragm, 68 Summary, 69 Answer Guide, 70 7 SHIFT OF THE MEDIASTINUM, 71 Questions, 72 Discussion, 73 ix x Contents Top 5 Diagnoses: Shift of the Mediastinum, 80 Summary, 80 Answer Guide, 81 8 WIDENING OF THE MEDIASTINUM, 82 Questions, 83 Discussion, 84 Top 5 Diagnoses: Widening of the Mediastinum, 95 Summary, 95 Answer Guide, 95 9 ANTERIOR MEDIASTINAL MASS, 96 Questions, 96 Discussion, 98 Top 5 Diagnoses: Anterior Mediastinal Mass, 107 Summary, 107 Answer Guide, 107 10 MIDDLE MEDIASTINAL MASS, 108 Questions, 110 Discussion, 112 Top 5 Diagnoses: Middle Mediastinal Mass, 126 Summary, 126 Answer Guide, 127 11 HILAR ENLARGEMENT, 128 Questions, 129 Discussion, 131 Top 5 Diagnoses: Hilar Enlargement, 144 Summary, 146 Answer Guide, 146 12 POSTERIOR MEDIASTINAL MASS, 147 Questions, 148 Discussion, 149 Top 5 Diagnoses: Posterior Mediastinal Mass, 162 Summary, 162 Answer Guide, 163 PART 2 Pulmonary Opacities 13 ATELECTASIS, 166 Questions, 167 Discussion, 169 Top 5 Diagnoses: Atelectasis, 184 Summary, 184 Answer Guide, 184 14 SEGMENTAL AND LOBAR CONSOLIDATIONS, 185 Questions, 185 Discussion, 187 Contents xi Top 5 Diagnoses: Segmental and Lobar Opacities, 195 Summary, 195 Answer Guide, 196 15 DIFFUSE AIR SPACE OPACITIES, 197 Questions, 198 Discussion, 201 Top 5 Diagnoses: Diffuse Air Space Opacities, 214 Summary, 215 Answer Guide, 215 16 MULTIFOCAL ILL-DEFINED OPACITIES, 216 Questions, 217 Discussion, 218 Top 5 Diagnoses: Multifocal Ill-Defined Opacities, 233 Summary, 233 Answer Guide, 234 17 DIFFUSE FINE NODULAR OPACITIES, 235 Questions, 236 Discussion, 237 Top 5 Diagnoses: Diffuse Fine Nodular Opacities, 245 Summary, 245 Answer Guide, 245 18 FINE RETICULAR OPACITIES, 246 Questions, 247 Discussion, 249 Top 5 Diagnoses: Fine Reticular Opacities, 257 Summary, 257 Answer Guide, 258 19 COARSE RETICULAR OPACITIES (HONEYCOMB LUNG), 259 Questions, 260 Discussion, 261 Top 5 Diagnoses: Coarse Reticular Opacities (Honeycomb