William D. Middleton III - General and Vascular Ultrasound E-Book: Case Review Series

General and Vascular Ultrasound: Case Review Series

Second Edition

William D. Middleton, MD, FACR

Professor of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri

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GENERAL AND VASCULAR ULTRASOUND: CASE REVIEW

ISBN-13: 978-1-4160-3989-1

ISBN-10: 1-4160-3989-9

Copyright 2007, 2002 by Mosby, Inc., an affiliate of Elsevier, Inc.

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NOTICE

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. 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 the practitioner, relying on their own experience and knowledge of the patient, 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 Editors assume any liability for any injury and/or damage to persons or property arising out or related to any use of the material contained in this book.

Library of Congress Cataloging-in-Publication Data

Middleton, William D.

General and vascular ultrasound: case review/William D. Middleton. 2nd ed.

p. cm. (Case review series)

Includes bibliographical references.

ISBN 1-4160-3989-9

1. Diagnosis, UltrasonicCase studies. 2. Blood vesselsUltrasonic imagingCase studies. I. Title.

RC78.7.U4M53 2007

616.07543dc22

2006050470

Acquisitions Editor: Maria Lorusso

Project Manager: Bryan Hayward

Printed in China

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Dedication

To my students. This book is for the current, past, and future sonographers, residents, and fellows whom I have worked with and helped to train. Their intellectual curiosity has kept me stimulated, and their passion for learning has rewarded me throughout my career.

To my teachers. They are too many to name, but their efforts were instrumental in guiding my career and inspiring me to accomplish all that I could.

To my mother and the memory of my father. Both were teachers, and any ability I have in education is in large part due to their influence.

To my children. They kept me happy and entertained, and focused my priorities throughout the process of writing the 2nd edition of this book.

To my wife. She is the love of my life. I know I am getting better at this since I managed to complete this edition without her noticing I was working on it.

SERIES FOREWORD

I have been very gratified by the popularity of the Case Review Series and the positive feedback the authors have received on the publication of the first edition volumes. Reviews in journals and word-of-mouth comments have been uniformly favorable. The authors have done an outstanding job in filling the niche of an affordable, easy-to-read, case-based learning tool that supplements the material in THE REQUISITES series. While some students learn best in a noninteractive study-book mode, others need the anxiety or excitement of being quizzed, being put on the hot seat. Recognizing this need, the publisher and I selected the format of the Case Review Series to simulate the Boards experience by showing a limited number of images needed to construct a differential diagnosis and asking a few clinical and imaging questions (the only difference being that the Case Review books give you the correct answer and immediate feedback!). Cases are scaled from relatively easy to very hard to test the limit of the readers knowledge. A brief authors commentary, a cross-reference to the companion REQUISITES volume, and an up-to-date literature reference are also provided for each case.

Because of the success of the series, we have begun to roll out the second editions of the volumes. The expectation is that the second editions will bring the material to the state-of-the-art, introduce new modalities and new techniques, and provide new and even more graphic examples of pathology.

This volume of the Case Review Series, General and Vascular Ultrasound by William D. Middleton, is the latest of the second editions. Once again Dr. Middleton has achieved the stated goals of the Case Review Series: a comprehensive review of the subject in an interactive format combining outstanding imaging, probing questions, and erudite discussion. The image quality of this volume is sensational, and the use of color helps explore the subject effectively. Dr. Middleton emphasizes color flow Doppler and its ever-increasing role in ultrasonography. I am sure that residents preparing for the oral Boards will find that this volume is a treasure trove of quality material that will serve them well in Louisville and beyond.

I am pleased to present for your viewing pleasure the fourth volume of the second editions of the Case Review Series, joining the previous second editions of Head and Neck Imaging by David M. Yousem and Carol da Motta, Genitourinary Imaging by Ronald J. Zagoria, William W. Mayo-Smith, and Julia R. Fielding, and Obstetric and Gynecologic Ultrasound by Karen L. Reuter and T. Kemi Babagbemi.

David M. Yousem, MD, MBA

PREFACE

In addition to technological advances that have occurred in the past five years, there has been a continual expansion in the scope of clinical practice that can be aided by sonography. Indications that were considered rare or unusual when the first edition of this book was written have now become routine in many practices. Therefore, it was an appropriate time to update this textbook with new cases as well as new images and new information for some of the cases in the first edition.

As before, one goal for this text was to accumulate a collection of cases that covered all the topics typically shown on contemporary board examinations. This material appears in all three sections of the book. Another goal was to make this book a useful tool for the practicing general radiologist. Therefore, the third section also includes some cases that may be encountered periodically in practice but are unlikely to show up on an examination. The new cases are scattered throughout all three sections and cover a wide variety of pathology, including disease centered in the abdomen, head and neck, scrotum, and the musculoskeletal system. But even with 229 cases, it is inevitable that some conditions relevant to the immensely broad practice of ultrasonography cannot be included in a book of this size.

As I worked on this new edition, I was reminded by the publishers that the addition of new cases also meant that some previous cases had to be removed. I found this to be the hardest part of the editing process. As I mentioned in the preface to the first edition, all of the cases shown come from patients I scanned while specifically attempting to capture images that showed important aspects about the abnormality or technical issue in question. So eliminating these cases reminded me of discarding notes taken during old med school classes. The material may not be as relevant as it was in the past, but the amount of effort exerted makes it very hard to part with it.