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Learning Radiology: Recognizing the Basics, 2nd Edition, is an image-filled, practical, and clinical introduction to this integral part of the diagnostic process. William Herring, MD, a skilled radiology teacher, masterfully covers everything you need to know to effectively interpret medical images. Learn the latest on ultrasound, MRI, CT, and more, in a time-friendly format with brief, bulleted text and abundant high-quality images. Then ensure your mastery of the material with additional online content, bonus images, and self-assessment exercises at www.studentconsult.com.

  • Identify a wide range of common and uncommon conditions based upon their imaging findings.
  • Quickly grasp the fundamentals you need to know through easy-access bulleted text and more than 700 images.
  • Arrive at diagnoses by following a pattern recognition approach, and logically overcome difficult diagnostic challenges with the aid of decision trees.
  • Learn from the best, as Dr. Herring is both a skilled radiology teacher and the host of his own specialty website, www.learningradiology.com.
  • Easily master the fundamental principles of MRI, ultrasound, and CT with new chapters that cover principles of each modality and the recognition of normal and abnormal findings.

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01 avril 2011

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Learning Radiology
Recognizing the Basics
Second Edition

William Herring, MD, FACR
Vice Chairman and Residency Program Director, Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
Mosby
Front Matter
SECOND EDITION

Learning Radiology
RECOGNIZING THE BASICS
William Herring, MD, FACR
Vice Chairman and Residency Program Director
Department of Radiology
Albert Einstein Medical Center
Philadelphia, Pennsylvania
Copyright

1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
LEARNING RADIOLOGY 978-0-323-07444-5
Copyright © 2012, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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 permission, 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 experience 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 determine 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.
Library of Congress Cataloging-in-Publication Data
Herring, William.
Learning radiology : recognizing the basics / William Herring. — 2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-323-07444-5 (pbk. : alk. paper)
1. Radiology, Medical—Study and teaching. I. Title.
[DNLM: 1. Radiography—methods. 2. Diagnosis, Differential. WN 200]
R899.H472 2012
616.07′572—dc22
2011006507
Acquisitions Editor: James Merritt
Developmental Editor: Andrea Vosburgh
Publishing Services Manager: Deborah Vogel
Project Manager: Brandilyn Tidwell
Designer: Ellen Zanolle
Illustrations Manager: Michael Carcel
Marketing Manager: Jason Oberacker
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedication
To my wife, Patricia,
and our family
Contributor

Daniel J. Kowal, MD, Computed Tomography Division Director Radiology Elective Director Department of Radiology Saint Vincent Hospital Worcester, Massachusetts
Chapter 20, Magnetic Resonance Imaging
Preface to the First Edition
If you’re the kind of person, like I am, who reads the preface after you’ve read the book, I hope you enjoyed it. If you’re the kind of person who reads the preface before reading the book, then you’re in for a real treat.
Suppose for a moment that you wanted to know what kind of bird with a red beak just landed on your windowsill (don’t ask why). You could get a book on birds that listed all of them alphabetically from albatross to woodpecker and spend time looking at hundreds of bird pictures. Or you could get a book that lists birds by the colors of their beaks and thumb through a much shorter list to find that it was a cardinal.
This is a red-beak book. Where possible, groups of diseases are first described by the way they look rather than by what they’re called . Imaging diagnoses frequently, but not always, rest on a recognition of a reproducible visual picture of that abnormality. That is called the pattern recognition approach to identifying abnormalities, and the more experience you have and more proficient you become at looking at imaging studies, the more comfortable and confident you’ll be with that approach.
Before diagnostic images can help you decide what disease the patient may have, you must first be able to differentiate between what is normal and what is not. That isn’t as easy as it may sound. Recognizing the difference between normal and abnormal probably takes as much, if not more, practice than deciding what disease the person has.
In fact, it takes so much practice, some people—I believe they are called radiologists —have actually been known to spend their entire life doing it. You won’t be a radiologist after you’ve completed this book, but you should be able to recognize abnormalities and interpret images better. By so doing, perhaps you can participate in the care of patients with more assurance and confidence.
In this text, you’ll spend time in each section learning how to recognize what is normal so that you can differentiate between such things as a skin fold and a pneumothorax or so that you can recognize whether that fuzzy white stuff at the lung bases is pneumonia or the patient simply hasn’t taken a deep breath.
Where pattern recognition doesn’t work, we’ll try whenever possible to give you a logical approach to reaching a diagnosis based on simple yet effective decision trees. These will be little decision trees—saplings with only a few branches—so that they are relatively easy to remember.
By learning an approach, you’ll have a method you can apply to similar problems again and again. Have you ever heard the saying “Give a man a fish; you have fed him for today. Teach a man to fish, and you have fed him for a lifetime”? Learning an imaging approach is like learning how to fish, except a lot less smelly. An approach will enable you to apply a rational solution to diagnostic imaging problems.
This text was written, in part, to make complementary use of the medium for which radiologic images are ideally suited: the computer screen. The web is ideal for accessing and displaying images, but many people do not want to read large volumes of text from their computer screens. So we’ve joined the text in the printed book with photos, quizzes, and tutorials available online at StudentConsult.com in a series of web enhancements that accompany every chapter.
This text is not intended to be encyclopedic. There are many wonderful radiology reference texts available, some of which contain thousands of pages and weigh slightly less than a Volkswagen. This text is oriented more towards students, interns, and residents or residents-to-be.
Not every imaging modality is covered equally in this book, and some are not covered at all. This book emphasizes conventional radiography because that is the type of study most patients have first and because the same imaging principles that apply to recognizing the diagnosis on conventional radiographs can be applied to making the diagnosis on more complex modalities.
With a better appreciation and understanding of why images look the way they do, you’ll soon be recognizing abnormalities and making diagnoses that will impress your mentors and peers and astound your friends and relatives.
Let’s get started.

William Herring, MD
Preface to the Second Edition
This second edition of Learning Radiology: Recognizing the Basics includes numerous changes and additions. There are additional chapters, over a hundred new photos, reorganization of key material throughout the text, and an increased emphasis on the cross-sectional imaging modalities of computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound.
Two entirely new chapters have been added to help you understand the basic principles and fundamental observations of ultrasound and MRI. Trauma has moved to its own chapter, bringing together related material to provide cohesive coverage of this important subject. A new and helpful appendix has been added, which lists the most appropriate imaging study to order for each of a myriad of clinical scenarios. This information should prove indispensable on clinical rounds.
Many chapters have been reorganized. The chapter on Recognizing Adult Heart Disease has been restructured to include relevant material featuring CT and MRI. The chapters on Diseases of the Chest and Diseases of the GI and Urinary Tracts have been updated with increased emphasis on CT, ultrasound, and MRI. The chapters on Reco

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