David D. Gover - Top 3 Differentials in Vascular and Interventional Radiology: A Case Review

Top 3 Differentials in Vascular and Interventional Radiology

A Case Review

David D. Gover, MD
Chief
Vascular & Interventional Radiology
David Grant USAF Medical Center
Travis Air Force Base
Associate Clinical Professor
Volunteer Faculty Series
University of California
Davis, California

Series Editor:

William T. OBrien, Sr., DO, FAOCR
Director, Pediatric Neuroradiology Fellowship
Cincinnati Children's Hospital Medical Center
Associate Professor of Radiology
University of Cincinnati College of Medicine
Cincinnati, Ohio

425 illustrations

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To My Eternal Sweetheart,
Shannon,
and our Top 3:
Brighton, Darby, and Reese.
These are the truest pearls!

William T. O'Brien, Sr.

The original Top 3 concept was something engrained in us during our residency training in the military. From day 1, our program emphasized the importance of having gamut-based differentials as part of our daily readout sessions, as well as during didactic and clinical case-based conferences. The bulk of residency training was then centered around learning the key clinical and imaging manifestations of each entity on the list of differentials to be able to distinguish one from another, when possible. To avoid providing clinicians with a laundry list of differentials that would be of little value, we were encouraged to consider the Top 3 differentials and any other important considerations based on the specific clinical scenario or imaging finding(s) presented. I found this concept and approach to radiology so useful that I continue to utilize it to this day.

One thing I learned throughout my radiology career, especially as a residency program director, is that not every individual learns or processes information in the same manner. Some individuals can read through a traditional textbook that is organized by pathology (i.e., developmental abnormalities, infectious processes, neoplasms, etc.) and readily recognize that the developmental abnormality in Chapter 1 is in the same differential for the infectious process in Chapter 2 and a few neoplasms in Chapter 3. Others, like me, best learn from gamut-based resources where content is organized based on the key imaging findings, similar to how we practice radiology. If you are part of the latter group, then the Top 3 approach may be the right fit for you. The intent of the series is to provide a comprehensive case-based alternative to traditional subspecialty textbooks where the focus remains on differential diagnoses. After all, when the dust settles and the core and certifying exams are nothing but distant (and hopefully pleasant) memories, this is what radiology is all about.

Vascular and Interventional Radiology (VIR) was one of the challenging subspecialties to incorporate into the Top 3 format, since VIR is often more focused on management and diagnostic or therapeutic approaches than on differential diagnoses. I was initially hesitant to include VIR as a subspecialty edition in this series until I broached the topic with Dr. David Gover. He had the idea of organizing the book in a similar manner as he approaches the field of VIRinitial patient work-up, differentials for imaging findings, cases where the diagnosis is known (Aunt Minnies), pertinent anatomy, and postprocedural management. The end result is an exceptionally creative adaptation of the Top 3 format to fit the practice of VIR, with clinical and management pearls presented throughout.

It is my sincere hope that you will find this unique approach to VIR both enjoyable and educational.

William T. OBrien, Sr., DO, FAOCR

The purpose of this book is to provide a framework for the student of interventional radiology (IR). This project began as I was preparing for my board recertification examination and morphed into something larger at the encouragement of the publisher. By no means is this an exhaustive work. I am well aware that there are many more qualified practitioners, who might author more comprehensive textbooks, but I believe that this compilation will help create an organized approach to many common IR situations via a case review format. My hope is that this work will be helpful to the medical student contemplating a career in IR, to residents in preparation for rotations or examinations, and to practicing radiologists who wish to hone their skills.