(BQ) Part 2 book “Brant and helms’ fundamentals of diagnostic radiology” has contents: Mesenteric small bowel, adrenal glands and kidneys, pelvicalyceal system, ureters, bladder, and urethra, abdomen ultrasound, genital tract and bladder ultrasound, obstetric ultrasound, vascular ultrasound, benign lucent bone lesions,…. And other contents.
SECTION VII ■ GASTROINTESTINAL TRACT SECTION EDITOR: William E Brant CHAPTER ■ ABDOMEN AND 40 PELVIS WILLIAM E BRANT AND JENNIFER POHL Imaging Methods Compartmental Anatomy of the Abdomen and Pelvis Fluid in the Peritoneal Cavity Pneumoperitoneum Abdominal Calcifications Acute Abdomen Small Bowel Obstruction Large Bowel Obstruction Bowel Ischemia and Infarction Abdominal Trauma Lymphadenopathy Abdominopelvic Tumors and Masses Hernias of the Abdominal Wall HIV and AIDS in the Abdomen IMAGING METHODS Conventional radiographs of the abdomen remain a mainstay for the assessment of the acute abdomen CT, US, and MR provide comprehensive evaluation of the abdomen including the peritoneal cavity, retroperitoneal compartments, abdominal and pelvic organs, blood vessels, and lymph nodes COMPARTMENTAL ANATOMY OF THE ABDOMEN AND PELVIS Knowledge of the complex compartmental anatomy of the abdomen and pelvis is fundamental to understanding the effects of pathologic processes and to correctly interpret imaging studies Understanding the shape and extent of anatomic compartments and their normal variations may clarify imaging findings that would otherwise be incomprehensible or lead to misdiagnosis Fundamental considerations include constant anatomic landmarks, ligaments and fascia that define compartments, and normal variations in size and appearance of the various compartments and recesses Identifying the precise compartment that an abnormality is in determines to a great extent the origin of the abnormality The peritoneal cavity is divided into the greater peritoneal cavity and the lesser peritoneal cavity (the lesser sac) (Figs 40.1 and 40.2) Within both portions of the peritoneal cavity are numerous recesses in which pathologic processes tend to loculate The right subphrenic space communicates around the liver with the anterior subhepatic and posterior subhepatic space (Morison pouch) Morison pouch (the right hepatorenal fossa) is the most dependent portion of the abdominal cavity in a supine patient and it preferentially collects ascites, hemoperitoneum, metastases, and abscesses The right subphrenic and subhepatic spaces communicate freely with the pelvic peritoneal cavity via the right paracolic gutter T he left subphrenic space communicates freely with the left subhepatic space, but is separated from the right subphrenic space by the falciform ligament and from the left paracolic gutter by the phrenicocolic ligament The left subphrenic (perisplenic) space distends with fluid from ascites and with blood from splenic trauma It is a common location for abscesses and for disease processes of the tail of the pancreas The left subhepatic space (gastrohepatic recess) is affected by diseases of the duodenal bulb, lesser curve of the stomach, gallbladder, and left lobe of the liver The falciform ligament consists of two closely applied layers of peritoneum extending from the umbilicus to the diaphragm in a parasagittal plane The caudal free end of the falciform ligament contains the ligamentum teres, which is the remnant of the obliterated umbilical vein Paraumbilical veins (portosystemic collateral vessels) that enlarge within the falciform ligament are a specific sign of portal hypertension The reflections of the falciform ligament separate over the posterior dome of the liver to form the coronary ligaments, which define the “bare area” of the liver not covered by peritoneum The coronary ligaments reflect between the liver and diaphragm and prevent access of ascites and other intraperitoneal processes from covering the bare area of the liver The lesser omentum, composed of the gastrohepatic and hepatoduodenal ligaments, suspends the stomach and duodenal bulb from the inferior surface of the liver The lesser omentum separates the gastrohepatic recess of the left subphrenic space from the lesser sac The lesser omentum transmits the coronary veins (which dilate as varices) and contains lymph nodes (which enlarge with involvement by gastric carcinoma and lymphoma) T he lesser sac is the isolated peritoneal compartment between the stomach and the pancreas It communicates with the rest of the peritoneal cavity (the greater sac) only through the small foramen of Winslow Pathologic processes in the lesser sac usually occur because of disease in adjacent organs (pancreas, stomach) rather than spread from elsewhere in the abdominal cavity The lesser sac is normally collapsed but can become huge when filled with fluid The greater omentum is a double layer of peritoneum that hangs from the greater curvature of the stomach and descends in front of the abdominal viscera separating bowel from the anterior abdominal wall The greater omentum encloses fat and a few blood vessels It serves as fertile ground for implantation of peritoneal metastases, and assists in loculation of inflammatory processes of the peritoneal cavity such as abscesses and tuberculosis FIGURE 40.1 Anatomy of the Peritoneal Cavity A: Diagram of an axial cross-section of the abdomen illustrates the recesses of the greater peritoneal cavity and the lesser sac B: CT scan of a patient with a large amount of ascites nicely demonstrates the recesses of the greater peritoneal cavity and the lesser sac The lesser sac is bounded by the stomach (St) anteriorly, the pancreas (P) posteriorly, and the gastrosplenic ligament (curved arrow) laterally The falciform ligament (arrowhead) separates the right and left subphrenic spaces Fluid from the greater peritoneal cavity extends into Morison pouch (arrow) between the liver and the right kidney Fluid in the gastrohepatic recess (*) separates the stomach from the liver (L) S, spleen; GB, gallbladder; RK, right kidney; IVC, inferior vena cava; Ao, aorta; LK, left kidney The retroperitoneal space between the diaphragm and the pelvic brim is divided into anterior pararenal, perirenal, and posterior pararenal compartments by the anterior and posterior renal fascia (Fi g 40.3) The anterior pararenal space extends between the posterior parietal peritoneum and the anterior renal fascia It is bounded laterally by the lateroconal fascia The pancreas, duodenal loop, and ascending and descending portions of the colon are within the anterior pararenal space Disease in the anterior pararenal space usually originates from these organs (pancreatitis, perforating/penetrating ulcer, diverticulitis) FIGURE 40.2 The Lesser Sac Sagittal plane diagrams of the medial (A) and lateral (B) aspects of the lesser sac illustrate its position posterior to the stomach and anterior to the posterior parietal peritoneum covering the pancreas Note that projections of the lesser sac extend to the diaphragm, resulting in the potential for disease processes in the lesser sac to cause pleural effusions The coronary ligaments reflect between the liver and the diaphragm producing a bare area of liver not covered by peritoneum The anterior and posterior renal fascias encompass the kidney, adrenal gland, and perirenal fat within the perirenal space The anterior renal fascia is thin and consists of one layer of connective tissue The posterior renal fascia is thicker, consisting of two layers of connective tissue The anterior layer of the posterior renal fascia is continuous with the anterior renal fascia The posterior layer of the renal fascia is continuous with the lateroconal fascia, forming the lateral boundary of the anterior pararenal space The anterior and posterior layers of the posterior renal fascia may be separated by inflammatory processes, such as pancreatitis, extending from the anterior pararenal space The renal fascia is bound to the fascia surrounding the aorta and vena cava usually preventing spread of disease to the contralateral perirenal space However, disease processes arising in the perivascular space, such as hemorrhage from aortic aneurysm rupture, may extend into the perirenal space Fluid collections in the perirenal space are usually renal in origin (infection, urinoma, hemorrhage) Bridging septa extend between the renal fascia and the renal capsule tends to cause loculations of fluid processes in the perirenal space The right perirenal space is open superiorly to the bare area of the liver allowing spread of disease processes (infection, tumor) between the kidney and liver FIGURE 40.3 Retroperitoneal Compartmental Anatomy Diagrams illustrate two normal variations of the reflections of the posterior parietal peritoneum around the descending colon In (A) the colon is entirely retroperitoneal and in (B) the peritoneum forms a deep pocket lateral to the colon, allowing intraperitoneal fluid to extend far posteriorly Fluid or disease processes in the anterior pararenal space from the pancreas or colon may also extend posteriorly to the kidney by separating the two layers of the posterior renal fascia The posterior pararenal space is a potential space, usually filled only with fat, extending from the posterior renal fascia to the transversalis fascia The posterior pararenal fat continues into the flank as the properitoneal fat “stripe” seen on plain films of the abdomen The compartment is limited medially by the lateral edges of the psoas and quadratus lumborum muscles Isolated fluid collections are rare and most commonly caused by spontaneous hemorrhage into the psoas muscle as a result of anticoagulation therapy FIGURE 40.4 Compartmental Anatomy of the Pelvis Diagram in the coronal plane illustrates the major anatomic compartments of the pelvis The pelvis is divided into three major anatomic compartments: peritoneal cavity, extraperitoneal space, and perineum ( Fig 40.4) The peritoneal cavity extends to the level of the vagina, forming the pouch of Douglas (cul-de-sac) in females, or to the level of the seminal vesicles, forming the rectovesical pouch in males The broad ligaments reflect over the uterus, fallopian tubes, and parametrial uterine vessels and serve as the anterior boundary of the rectouterine pouch of Douglas The cul-de-sac is the most dependent portion of the peritoneal cavity and collects fluid, blood, abscesses, and intraperitoneal drop metastases The extraperitoneal space of the pelvis is continuous with the retroperitoneal space of the abdomen, extends to the pelvic diaphragm, and includes the retropubic space (of Retzius) Pathologic processes from the pelvis spread preferentially into the retroperitoneal compartments of the abdomen T h e perineum lies below the pelvic diaphragm The ischiorectal fossa serves as its anatomic landmark (Fig 40.5) FIGURE 40.5 Perineal Tumor A CT scan of a 12-year-old girl with a history of a rhabdomyosarcoma of the right leg demonstrates a tumor metastasis (T) in the right ischiorectal fossa The left ischiorectal fossa (IRF) shows its normal appearance as a triangle of fat bordered by the rectum (R), obturator internus muscle (OI), and the gluteus muscles (GM) The ischiorectal fossa is entirely below the levator ani and is part of the perineum c, tip of the coccyx; IT, ischial tuberosities FLUID IN THE PERITONEAL CAVITY Fluid in the peritoneal cavity originates from many different sources and varies greatly in composition Ascites is serous fluid in the peritoneal cavity most commonly caused by cirrhosis, hypoproteinemia, or congestive heart failure Exudative ascites results from inflammatory processes such as abscess, pancreatitis, peritonitis, or bowel perforation Hemoperitoneum results from trauma, surgery, or spontaneous hemorrhage Neoplastic ascites is associated with intraperitoneal tumors Urine, bile, and chyle may also spread freely within the peritoneal cavity Conventional radiographic diagnosis of ascites requires that at least 500 cc of fluid be present Findings are (a) diffuse increase in density of the abdomen (gray abdomen), (b) indistinct margins of the liver, spleen, and psoas muscles, (c) medial displacement of gas-filled colon, liver, and spleen away from the properitoneal flank stripe, (d) bulging of the flanks, (e) increased separation of gas-filled small bowel loops, and (f) “dog’s ears” appearance of symmetric densities in the pelvis due to fluid spilling out of the cul-de-sac on either side of the bladder CT demonstrates fluid density in the recesses of the peritoneal cavity The CT density of the fluid gives a clue as to its composition Serous ascites has attenuation values near water (−10 to +10 H) Exudative ascites is usually above +15 H and acute bleeding into the peritoneal cavity averages +45 H US is sensitive to small amounts of fluid in the peritoneal recesses Care must be taken with US to examine the most gravity-dependent portions of the peritoneal cavity (Morison pouch and the pe lvis) Simple ascites is anechoic, while exudative, hemorrhagic, or neoplastic ascites often contains floating debris Septations in ascites are associated with an inflammatory or malignant process MR shows limited specificity for defining the type of fluid present Serous fluid is low signal intensity on T1WI and markedly increased in signal intensity on T2WI Hemorrhagic fluid shows high signal intensity on both T1WI and T2WI Serous ascites is commonly bright on gradient-echo images due to fluid motion Pseudomyxoma peritonei (“jelly belly”) refers to gelatinous ascites that occurs as a result of intraperitoneal spread of mucin-producing cells resulting from rupture of appendiceal mucocele, or intraperitoneal spread of benign or malignant mucinous cysts of the ovary or mucinous adenocarcinoma of the colon or rectum Conventional radiographs may demonstrate punctate or ringlike calcifications scattered through the peritoneal cavity CT demonstrates mottled densities, septations, and calcifications within the fluid The mucinous fluid is typically loculated and causes mass effect on the liver and bowel (Fig 40.6) US demonstrates intraperitoneal nodules that range from hypoechoic to strongly echogenic PNEUMOPERITONEUM Free air within the peritoneal cavity is a valuable sign of bowel perforation, most commonly caused by duodenal or gastric ulcer perforation However, additional causes of pneumoperitoneum include trauma, recent surgery or laparoscopy, and infection of the peritoneal cavity with gas-producing organisms Postoperative pneumoperitoneum usually resolves in to days Serial images demonstrate a progressive decrease in the amount of air present Failure of progressive resolution, or an increase in the amount of air present, suggests a leak of bowel anastomosis or sepsis Pneumoperitoneum in the absence of a ruptured viscus may occur with air introduced through the female genital tract by orogenital insufflation, or associated with pulmonary emphysema, alveolar rupture, and dissection of air into the peritoneal cavity FIGURE 40.6 Pseudomyxoma Peritonei A CT scan of a 60-year-old man with intraperitoneal spread of mucinous adenocarcinoma of the colon shows loculations (arrowheads) of fluid indenting the surface of the liver (L) giving evidence of mass effect The attenuation of the fluid measured 32 H indicating exudative ascites Conventional radiographs show pneumoperitoneum best on images obtained with the patient in the standing or sitting position Upright chest radiographs are the most sensitive for free air Small amounts of air are clearly demonstrated beneath the domes of the diaphragm Left lateral decubitus and cross-table lateral views may be used with very ill patients to demonstrate air outlining the liver Signs of pneumoperitoneum on supine radiographs (Fig 40.7) include the following: (a) gas on both sides of the bowel wall (Rigler sign), (b) gas outlining the falciform ligament, (c) gas portal venography for TIPS planning, 907f technique and surveillance, 905–906, 906f, 908f, 909f Transpapillary hemorrhage, 872 Transposition of the great arteries (TGA), 714 Trans-spatial diseases, 213 perineural disease, 213 Transtentorial herniation, 63–64 Transthoracic echocardiography (TTE), 631 for cardiac masses, 680 Transthoracic needle biopsy (TNB), 270, 368 Transurethral resection of the prostate (TURP), 899 Transventricular plane, 1224, 1225f Trauma, 248–253, 1377, 1631 See also Accidental trauma in children; Skeletal trauma abdominal, 984–985 acute physeal, 1532 bladder extraperitoneal bladder rupture, 1131 intraperitoneal bladder rupture, 1131, 1131f blunt force, 1479 chronic physeal, 1532 cord contusion, 249, 252f epidural hematoma, 250, 253f mesenteric, 877, 879f nerve root avulsion, 250–252, 252f nonaccidental trauma (NAT) in children, 1545, 1545f–1546f skeletal scintigram interpretation, 1631 Traumatic diaphragmatic hernia, 500, 503f Traumatic lung disease pulmonary contusion, 504, 505f pulmonary hematomas, 504 pulmonary laceration, 504, 505f traumatic lung cyst, 504 Trevor disease, 1549, 1549f Trichobezoars, 1057, 1058f Tricuspid atresia (TA), 714 Tricuspid atresia, without TGA, 1491, 1492f chest radiograph of, 1491, 1492f Tricuspid stenosis, 714 Tricuspid valve, 701 congenital tricuspid valve disease, 714, 715f–717f Triplane fractures, 1539, 1540f–1541f Tropical sprue, 1075–1076 Troponin, 852 True fast imaging with steady-state precession (FISP), 10 True unilateral hyperlucent lung, 301 Trummerfeld zone, 1563, 1563f Truncation error, 12–13 Truncus arteriosus, 1489, 1490f Tuberculomas, 149–151, 152f, 400 in AIDS patients, 170 Tuberculosis (TB), 1474, 1475f in immunocompromised host, 412–413 miliary, 400, 402f postprimary, 400, 401f primary, 400, 400f of spine, 233 Tuberculous abscess, 152 Tuberculous colitis, 1089 Tuberculous esophagitis, 1044, 1044f Tuberculous meningitis, 143, 145f Tuberous sclerosis (TS), 436, 1446–1449, 1449f–1450f Tumefactive demyelinating lesion (TDL), 174, 176f Tumors, 207–209 See also Neoplasms abdominopelvic, 986–988 calcification, 977 fibrotic ovarian, 1143 neuroendocrine primary bone, 1636 skeletal scintigram interpretation, 1652 stages of, 552 Tunneled central venous catheter, 833, 833f Turbo spin-echo (TSE) sequence, Turcot syndrome, 1084 T2-weighted images (T2WI), 172 T2-weighted imaging, 639 Twin anemia–polycythemia sequence (TAPS), 1222 Twin embolization syndrome, 1222 Twinkle artifact, 17, 18f Twinkling sign, 1175 Twin reversed arterial perfusion (TRAP) sequence, 1222 Twins, 1222, 1222f Twin-to-twin transfusion syndrome (TTTS), 1222 Type A aortic dissections, 672 Typhlitis, 1088, 1088f U Ulcerative colitis (UC), 1085–1086, 1086f, 1510–1511 Ultrasonography, 15–18 acoustic windows, 15 artifacts, 17, 17f acoustic enhancement, 17, 17f acoustic shadowing, 17, 17f comet tail, 17 mirror image, 17, 18f reverberation, 17 twinkle, 17, 18f biosafety considerations, 18 bladder, 1202–1204 chest lung parenchyma, 1234 mediastinum, 1237 pleural space, 1234 for deep venous thrombosis, 844 Doppler US, 15–16, 16f elastography, 17 endoluminal techniques, 15 endoscopic, 15 female genital tract, 1182 ovaries and adnexa, 1186–1194 uterus, 1182–1186 male genital tract prostate, 1201–1202 testes and scrotum, 1194–1201 principles of interpretation, 17–18 anechoic lesion, 18 echo-containing cystic structures, 18 hyperechoic lesion, 18 hypoechoic lesion, 18 pulse-echo technique, 15, 15f tissue harmonic imaging, 16–17 transducers, 15 broad band, 15 high-frequency, 15 lower-frequency, 15 sector versus linear array, 16 water-soluble gel, use of, 15 Ultrasound-guided needle biopsy, 938 See also Image-guided needle biopsies Ultrasound imaging of breast, 539 axillary nodes, 550 high-resolution ultrasound, 544–545 lexicon, 569–574, 571f angular margin, 570 circumscribed margins, 570 cysts, 571, 573f echo pattern of mass, 571 indistinct margin, 570 lymph nodes, 571 microlobulated margin, 570 not-circumscribed margins, 570 posterior features, 571, 573f spiculated margin, 570 localizations, 615 shape, 570f of simple cyst, 545f of solid or cystic mass, 546 US-guided biopsy, 603f–605f, 604 Umbilical cord, 1220 normal, 1220, 1220f single-artery, 1220 Umbilical-urachal sinus, 1127 Umbilical venous catheter (UVC), 1467, 1467f, 1468 Uncal herniation, 63, 64f, 112 Undescended testis, 1196 Unfractionated heparin (UFH), 800 Unicameral bone cysts, 1386f, 1387 Unicuspid aortic valve, 764, 765f Unilateral diaphragmatic elevation, 497, 499 Unilateral locked facets, 1317, 1318f Units, radiation, 1583–1584 Upper airway evaluation of, 1479 infections, 1479–1480 Upper esophageal sphincter (UES), 1036 Upper extremity venous ultrasound deep venous thrombosis, 1273 technique, 1273 Upper gastrointestinal hemorrhage, 872, 873f–875f, 1064 Upper gastrointestinal (UGI) series, 1034 Urachal carcinoma, 1127, 1127f Urachal cyst, 1127 Ureter anatomy, 1117 extrarenal pelvis, 1117 fornix of calyx, 1117 infundibula, 1117 transitional epithelium, 1117 congenital anomalies bifid renal pelvis, 1118 retrocaval ureter, 1119 ureteral duplication, 1118 ureteropelvic junction obstruction, 1119 imaging methods, 1117 mass or filling defect in, 1123–1125 blood clots, 1123 calculi, 1123 fibroepithelial polyp, 1125 leukoplakia, 1125 malacoplakia, 1125 metastases, 1125 papillary necrosis, 1125, 1125f pyeloureteritis cystica, 1125 squamous cell carcinoma, 1125 transitional cell carcinoma (TCC), 1123–1125, 1123f–1125f papillary cavities, 1126 stricture of, 1125–1126 Ureteral stent, 896, 897f Ureterolithiasis, 1120 Ureteropelvic junction (UPJ), 1118 obstruction, 1514 Ureterovesical junction (UVJ), 1118, 1515–1516 Urethra anatomy anterior, 1132 female, 1133–1134, 1133f posterior, 1132 prostatic, 1132 utricle, 1132 verumontanum, 1132 imaging methods, 1132 pathology diverticulum of female urethra, 1134 posterior urethral valves, 1134 traumatic injury, 1134, 1134f urethral diverticuli, 1134 urethral strictures, 1133–1134 Urethral diverticulum, 1204, 1204f Urinary calculi, 976 Urinary tract dilation (UTD) classification system, 1514–1515, 1517f Urinary tract stones, 1120 Urticaria pigmentosa, 1375 Usual interstitial pneumonia (UIP), 421, 431–432, 432f, 449 Uterine arteriovenous malformations, 1186, 1187f Uterine artery, 890, 891f Uterine artery embolization (UAE), 890–894 complications of, 893 contraindications to, 890 embolic agents for, 893 in IR fluoroscopy suite, 891 outcomes assessment, 894 pain control after, 893 patient observation after, 893 pelvic arterial anatomy and, 890 preprocedural MRI, 891, 891f preprocedural workup, 891 sedation for, use of, 891 technique, 892–893, 892f, 893f uterine fibroids and, 890 Uterine fibroids, 890 classification, 891 medical management, 890 surgical management, 890 uterine artery embolization for (See Uterine artery embolization (UAE)) Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire, 894 Uterine leiomyomas, 1218 Uterine sarcomas, 1146–1147 Uterus anatomy of, 1136 congenital anomalies of, 1182–1183 Uterus ultrasound, 1182–1186 adenomyosis, 1184, 1184f arcuate artery calcifications, 1182 congenital anomalies, 1182–1183 fluid in endometrial cavity, 1186, 1186f intrauterine contraceptive devices, 1186, 1187f leiomyomas, 1183–1184, 1183f leiomyomasarcoma, 1184, 1184f Nabothian cysts, 1186, 1186f normal US anatomy, 1182, 1183f postmenopausal bleeding, 1184–1186, 1185f, 1186f thickened endometrium, 1184 uterine arteriovenous malformations, 1186, 1187f Utricle cyst, 1202, 1203f V Valve disease acquired diseases of multiple valves carcinoid heart disease, 718–719, 719f infective endocarditis, 717–718 nonbacterial endocarditis, 718 rheumatic heart disease, 718, 718f aortic valve acquired aortic valve disease, 708 aortic regurgitation, 710–711, 712f aortic stenosis, 708, 710, 711f congenital aortic valve disease, 707–708, 709f, 710f imaging evaluation of cardiac MRI, 707 echocardiography, 702 phase-contrast MRI, 707, 707f, 708f quantification of ventricular stroke volume, 707 radiography and CT, 702–703, 703f–706f mitral valve acquired mitral valve disease, 711, 713–714, 713f, 714f, 715f congenital mitral valve disease, 711, 712f postoperative complications following valve surgery, 719, 720f pulmonary valve pulmonary regurgitation, 717, 718f pulmonary stenosis, 714, 716–717, 717f structure and function of valves and, 701–702, 702f aortic valve, 701, 703f mitral valve, 701, 702f pulmonary valve, 701–702, 703f tricuspid valve, 701 tricuspid valve congenital tricuspid valve disease, 714, 715f–717f Valvular papillary fibroelastoma, 686–688, 687f Valvular regurgitation, 707, 707f, 708f, 1665–1666 regurgitant fraction (RF), 707 regurgitant volume (RVol), 707 Valvular vegetations, 696 Variceal occlusion, 907–908 Varicella pneumonia, 402, 406f Varicella zoster virus (VZV), 159–160 Varices, 1047, 1048f downhill, 1047 uphill, 1047 Varicoceles, 1196, 1200, 1200f Varicoid carcinoma, 1047 Vasa previa, 1219, 1219f Vascular and interventional radiology (VIR), medications used in, 796–803 See also Medications, used in VIR Vascular calcifications, 562, 565f Vascular catheters, 815 Vascular diseases, 248 cavernous malformations, 248 extramedullary AVM, 248 intramedullary AVM, 248 spinal AVM, 248 spinal cord infarction, 248 Vascular Doppler ultrasound, in PAD, 819 Vascular injuries, 60 carotid artery dissection, 61f carotid cavernous fistula, 63f posttraumatic pseudoaneurysm, 62f Vascular lesions, 216, 218f, 328 Vascular malformations, 103 arteriovenous malformations, 103–104 cavernous malformations, 105, 106f telangiectasias, 104 venous malformations, 104–105 Vascular orbital lesions, 217 Vascular phenomena, skeletal scintigram interpretation, 1632–1634 Vascular ultrasound, 1252 abdominal vessels anatomy, 1264 carotid, 1257–1260 carotid occlusion, 1262 carotid stenosis, 1258–1260 pathology, 1265 carotid US diagnosis, approach to, 1264 common pitfalls, 1263 angle of insonation, 1263 bilateral ICA stenosis, 1263 calcified plaque, 1263 carotid bulb, 1263 carotid dissection, 1263 fibromuscular dysplasia, 1264 low PSV, 1264 mistaking ECA for ICA, 1263 near occlusion of ICA, 1263 nonatherosclerotic carotid disease, 1263 post carotid stent placement, 1264 postendarterectomy, 1264 radiation injury, 1264 Takayasu arteritis, 1264 tandem lesions, 1263 tardus parvus waveforms, 1264 tortuous and narrow vessels, 1263 unilateral high grade carotid stenosis, 1263 valvular heart disease, 1264 Doppler ultrasound, 1252–1257 peripheral artery, 1268–1270 anatomy, 1267 aneurysm, 1268 arteriovenous fistulas, 1267 graft surveillance, 1269–1270 hematoma, 1268 occlusion, 1268–1269 pseudoaneurysm, 1268 stenosis, 1268 venous anatomy, 1270 lower extremity, 1270 technique, 1270 upper extremity, 1273–1276 Vasculitis, 97 Vasoconstrictors, 799 Vasodilators, 798–799 Vasopressin, 799 Vasospasm, 824–825, 826f Vegetations, 696 Vein mapping, lower extremity venous ultrasound, 1273 Velocity ratios, 1255 VenaTech LP filter, 861f Venipuncture technique femoral vein approach, 835 internal jugular vein approach, 834, 835f subclavian vein approach, 835 Venography, 846 Venous infarction, 97, 97f, 98f Venous system of lower extremity, 839, 840f deep veins, 839, 840f Egyptian eye appearance, 839, 840f perforating veins, 839, 840f superficial veins, 839, 840f of upper extremity, 841f Venous thromboembolism (VTE), 839 See also Deep venous thrombosis (DVT); Inferior vena cava (IVC) filters; Pulmonary embolism (PE) Venous ultrasound lower extremity anatomy, 1270–1271 chronic venous insufficiency, 1273 deep venous thrombosis, 1271–1272 vein mapping, 1273 upper extremity anatomy, 1273 deep venous thrombosis, 1274, 1275 thoracic outlet syndrome, 1274 Ventilation lung scans krypton-81m ventilation scanning, 1613–1614 normal, 1615 radiopharmaceuticals for, 1612–1613 technetium-99m aerosol ventilation scanning, 1614 technique, 1613 Ventilation/perfusion (V/Q) scans abnormal, 1617 CT angiography versus ventilation/perfusion scans, 1614–1615 indications, 1614 interpretation clinical assessment, 1622 diagnostic criteria, 1619 false-negative, 1623 false-positive, 1623 follow-up V/Q scans post anticoagulation, 1622–1623 perfusion defect, 1618 PIOPED findings, 1621 pulmonary angiography and, 1622 with SPECT and low-dose CT, 1622 stripe and fissure signs, 1619–1621 lung scintigraphy, 269, 351 normal perfusion scans, 1615 normal ventilation scans, 1615 pulmonary embolus, 1579 Ventricular meningioma, 129–131 Ventricular septal defect (VSD), 1485–1486, 1486f conal, 1485 muscular, 1485 perimembranous defects, 1485 pulmonary vascularity in, 1485, 1486f, 1488 Ventricular septal rupture (VSR), 672 Ventricular stroke volume, quantification of, 707 Ventricular system, brain scan, 28 Ventriculogram, exercise radionuclide, 1666 Ventriculomegaly, 1225, 1225f Verapamil, 798 Verocay bodies, 127 Vertebral abnormalities, 329–331 Vertebral arteries, 89, 91f Vertebral fractures, 1545 Vesical-urachal diverticulum, 1127 Vesicles, seminal anatomy, 1151–1152 pathology, 1152 Vesicoureteral reflux (VUR), 1123, 1514–1518 direct visualization of, 1518 induced pyelonephritis, 1515 methods of assessment for, 1518 Vessel wall, inherited disorders of Ehlers–Danlos syndrome, 828, 828f fibromuscular dysplasia, 828, 828f Loeys–Dietz syndrome, 828 Marfan syndrome, 827–828 Vestibular schwannomas, 127, 129, 129f Video-assisted thoracoscopic surgery (VATS), 368, 481 Villous tumors, 1056 Viral hepatitis acute, 996 chronic, 996 Viral infections, 159–163 acute disseminated encephalomyelitis, 163, 166f cerebellitis, 162–163, 165f cytomegalovirus, 160 encephalitis, 160, 162, 164f herpes simplex, 159, 160f, 161–162f subacute sclerosing panencephalitis, 160, 163f varicella zoster virus, 159–160 Viral pneumonia, 401–402, 406 adenovirus, 402 in immunocompromised host, 413 influenza, 402, 405f respiratory syncytial virus and parainfluenza virus, 402, 405f Varicella zoster, 402 Virchow–Robin spaces, 94, 96f, 179, 181f Virchow triad, 842 Visceral catheters, 813f Vitamin K, 799, 800 Voiding cystourethrography, 1515, 1518 Voiding urosonography, 1518 Volkmann ischemic contractures, 1536 Volvulus cecal, 983 sigmoid, 982 small bowel, 982 Von Hippel–Lindau syndrome, 125, 241, 1101, 1449, 1452f von Meyenburg complexes, 1008, 1008f Von Recklinghausen disease See Neurofibromatosis type I (NF1) Voxel, W Wall-echo-shadow (WES) sign, 1166, 1166f Walled-off necrosis (WON), 1021, 1022f Wall motion, 1664–1665 Wandering spleen, 1029, 1167 Warfarin, 799, 800 for deep venous thrombosis, 844 Warthin tumor, 209 Water-based angiographic contrast agents, 809 Watershed (borderzone) infarction, 93, 94f Water-soluble contrast agents, 18, 20 Water-soluble iodinated contrast media, 23 Wedged hepatic venous pressure (WHVP), 902 Weigert–Meyer rule, 1514, 1516f Wernicke encephalopathy, 186–187, 190 Wernicke–Korsakoff syndrome, 186 West Nile encephalitis, 160, 164f West Nile virus (WNV), 195 Whipple disease, 1077 White matter and neurodegenerative diseases cerebrospinal fluid dynamics, 191–193 demyelinating diseases, 172–189 dysmyelinating diseases, 189–191 neurodegenerative disorders, 193–196 White matter injury of prematurity (WMOP), 1443 William syndrome, 1484 Wilms tumor, 1521–1523, 1524f staging, 1525 Wilson disease, 195 Winged scapula, 493, 496 Wolman disease, 1103 X Xanthogranuloma, 1474 Xanthogranulomatous cholecystitis, 1017 Xanthogranulomatous kidneys, 1178–1179 Xanthogranulomatous pyelonephritis, 1179 Xenon-127 radiopharmaceutical for ventilation lung scan, 1612–1613 ventilation scanning, 1613 Xenon-133 radiopharmaceutical for ventilation lung scan, 1612–1613 ventilation scanning, 1613 X-ray photons, 807–809, 808f Y Yersinia enterocolitis, 1078 Z Zenker diverticulum, 1041, 1041f Zika virus (ZIKV), 139–140, 141f Z line, 1035 Zollinger–Ellison syndrome, 1063 Zygomatic arch fractures, 72–73 Zygomaticomaxillary complex fracture, 72f, 73 Zygomycosis, 415, 416f ... vessels, and lymph nodes COMPARTMENTAL ANATOMY OF THE ABDOMEN AND PELVIS Knowledge of the complex compartmental anatomy of the abdomen and pelvis is fundamental to understanding the effects of pathologic... anatomic landmarks, ligaments and fascia that define compartments, and normal variations in size and appearance of the various compartments and recesses Identifying the precise compartment that... air, and food, and eventual cessation of absorption Stasis results in the overgrowth of bacteria and production of toxins that may injure the mucosa Compromise of blood supply may occur because of