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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. 2015v1.0 2 nd EDITION MÜLLER’S IMAGING OF THE CHEST EDITORS CHRISTOPHER M. WALKER, MD Associate Professor of Radiology University of Kansas Medical Center Kansas City, Kansas JONATHAN H. CHUNG, MD Associate Professor Section Chief of Thoracic Radiology Interim Vice Chair for Quality Department of Radiology The University of Chicago Medicine Chicago, Illinois ASSOCIATE EDITORS STEPHEN B. HOBBS, MD Assistant Professor Department of Radiology and Medicine University of Kentucky Lexington, Kentucky BRENT P. LITTLE, MD Division of Thoracic Imaging Department of Radiology Massachusetts General Hospital Boston, Massachusetts CAROL C. WU, MD Associate Professor Department of Diagnostic Radiology The University of Texas MD Anderson Cancer Center Houston, Texas 1600 John F. Kennedy Blvd. Ste 1600 Philadelphia, PA 19103-2899 MÜLLER’S IMAGING OF THE CHEST, SECOND EDITION ISBN: 978-0-323-46225-9 Copyright © 2019 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 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. Previous editions copyrighted 2008 by Saunders, an imprint of Elsevier Inc. Library of Congress Control Number: 2018953443 Publisher: Russell Gabbedy Senior Content Development Specialist: Ann Ruzycka Anderson Publishing Services Manager: Catherine Albright Jackson Senior Project Manager: Claire Kramer Design Direction: Ryan Cook Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 To Eunhee, thank you for your constant support and pushing me to take on this project. You truly make me a better man. To Elsie, thank you for always loving me and making me aware of the things that matter most in life. To Lillian, thank you for always making me laugh and giving the biggest hugs a dad could ever ask for. CMW To my parents, Kyu Youl and Bok Hee: Thank you for endlessly encouraging my curiosity. To my daughter, Alexandra: Thank you for always being so excited to see me when I come home; it is the only time I have felt like a rock star. And to my loving wife, Aimee-Sue: Thank you for being the backbone of our family. Your unending support and love always inspire me. JHC CONTRIBUTORS Kiran Batra, MD Stephane L. Desouches, DO Assistant Professor Assistant Professor of Radiology Department of Radiology Medical College of Wisconsin UT Southwestern Medical Center Milwaukee, Wisconsin Dallas, Texas Robert M. DeWitt, MD, Major, USAF MC Matthew Bentz, MD Assistant Professor of Radiology Assistant Professor Uniformed Services University of the Health Sciences Department of Diagnostic Radiology Bethesda, Maryland Oregon Health and Science University Landstuhl Regional Medical Center Portland, Oregon Landstuhl, Germany Marcelo F. Benveniste, MD Jeremy J. Erasmus, MD Associate Professor Professor Department of Diagnostic Radiology Department of Diagnostic Radiology Thoracic Section The University of Texas MD Anderson Cancer Center The University of Texas MD Anderson Cancer Center Houston, Texas Houston, Texas Stephen K. Frankel, MD Anupama Brixey, MD Chief Medical Officer Department of Diagnostic Radiology Professor of Medicine Oregon Health and Science University Division of Pulmonary, Critical Care, and Sleep Medicine Portland, Oregon Department of Medicine National Jewish Health Juliana Bueno, MD Denver, Colorado Assistant Professor of Radiology Department of Radiology and Medical Imaging Tomás Franquet, MD University of Virginia Chief, Section of Thoracic Imaging Charlottesville, Virginia Department of Radiology Hospital de Sant Pau Suzanne C. Byrne, MD, FRCPC Barcelona, Spain Clinical Assistant Professor of Radiology Department of Radiology Cristina S. Fuss, MD Memorial University Associate Professor St. John’s, Newfoundland, Canada Department of Diagnostic Radiology Oregon Health and Science University Brett W. Carter, MD Portland, Oregon Associate Professor Department of Diagnostic Radiology Sherief Garrana, MD The University of Texas MD Anderson Cancer Center Resident Physician Houston, Texas Department of Thoracic Radiology University of Missouri–Kansas City/Saint Luke’s Hospital of Jonathan H. Chung, MD Kansas City Associate Professor Kansas City, Missouri Section Chief of Thoracic Radiology Interim Vice Chair for Quality Matthew D. Gilman, MD Department of Radiology Division of Thoracic Imaging and Intervention The University of Chicago Medicine Massachusetts General Hospital Chicago, Illinois Boston, Massachusetts Patricia M. de Groot, MD J. David Godwin, MD Associate Professor Professor of Radiology Department of Diagnostic Radiology Department of Radiology The University of Texas MD Anderson Cancer Center University of Washington Houston, Texas Seattle, Washington vi Contributors vii Daniel R. Gomez, MD John P. Lichtenberger, MD Associate Professor Associate Professor of Radiology Department of Radiation Oncology Uniformed Services University of the Health Sciences The University of Texas MD Anderson Cancer Center Bethesda, Maryland Houston, Texas Rebecca M. Lindell, MD Ashish Gupta, MD Assistant Professor Assistant Professor Department of Radiology Department of Medical Imaging Mayo Clinic University of Ottawa Rochester, Minnesota Ottawa, Ontario, Canada Brent P. Little, MD Vedant Gupta, MD Division of Thoracic Imaging Assistant Professor of Medicine Department of Radiology University of Kentucky College of Medicine Massachusetts General Hospital Lexington, Kentucky Boston, Massachusetts Thomas E. Hartman, MD Jaume Llauger, MD Professor Chief, Section of Musculoskeletal Imaging Department of Radiology Department of Radiology Mayo Clinic Hospital de la Santa Creu i Sant Pau Rochester, Minnesota Universitat Autònoma de Barcelona Barcelona, Spain Stephen B. Hobbs, MD Assistant Professor Andrea L. Magee, MD Department of Radiology and Medicine Resident Radiologist University of Kentucky Department of Radiology Lexington, Kentucky The University of Chicago Chicago, Illinois Yeon Joo Jeong, MD Department of Radiology Victorine V. Muse, MD Pusan National University Hospital Assistant Professor of Radiology Pusan National University School of Medicine Harvard Medical School Busan, South Korea Massachusetts General Hospital Boston, Massachusetts Michael A. Kadoch, MD Assistant Professor of Clinical Radiology Justin M. Oldham, MD, MS Department of Radiology Assistant Professor University of California–Davis Department of Internal Medicine Sacramento, California Division of Pulmonary, Critical Care, and Sleep Medicine University of California–Davis Jeffrey S. Klein, MD Sacramento, California A. Bradley Soule and John P. Tampas Green and Gold Professor of Radiology Melissa Price, MD Department of Radiology Instructor in Radiology University of Vermont College of Medicine Division of Thoracic Imaging and Intervention Burlington, Vermont Massachusetts General Hospital Boston, Massachusetts Sarah T. Kurian, MD Department of Radiology Steven L. Primack, MD University of Missouri–Kansas City Professor and Vice Chair Kansas City, Missouri Department of Diagnostic Radiology Oregon Health and Science University Kyung Soo Lee, MD Portland, Oregon Department of Radiology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul, South Korea viii Contributors Bradley S. Sabloff, MD Mylene T. Truong, MD Professor Professor Department of Diagnostic Radiology Department of Diagnostic Radiology The University of Texas MD Anderson Cancer Center The University of Texas MD Anderson Cancer Center Houston, Texas Houston, Texas Jean M. Seely, MDCM, FCRPC Emily B. Tsai, MD Associate Professor Department of Radiology University of Ottawa Stanford University Head of Breast Imaging Section Stanford, California Department of Medical Imaging The Ottawa Hospital Chitra Viswanathan, MD Clinician Investigator Professor Ottawa Hospital Research Institute Department of Diagnostic Radiology Ottawa, Ontario, Canada Division of Diagnostic Imaging The University of Texas MD Anderson Cancer Center Phillip A. Setran, MD Houston, Texas Radiology Resident Department of Diagnostic Radiology Christopher M. Walker, MD Oregon Health and Science University Associate Professor of Radiology Portland, Oregon University of Kansas Medical Center Kansas City, Kansas Girish S. Shroff, MD Associate Professor Charles S. White, MD Department of Diagnostic Radiology Professor The University of Texas MD Anderson Cancer Center Department of Diagnostic Radiology Houston, Texas University of Maryland Baltimore, Maryland Justin T. Stowell, MD Resident Carol C. Wu, MD Department of Radiology Associate Professor University of Missouri–Kansas City Department of Diagnostic Radiology Kansas City, Missouri The University of Texas MD Anderson Cancer Center Houston, Texas Nicola Sverzellati, MD, PhD Professor of Radiology Department of Medicine and Surgery University of Parma Parma, Italy FOREWORD The aim of this second edition of Imaging of the Chest is to provide diagnosis, while knowledge of the pathologic findings allows a a succinct, state-of-the art overview of imaging of the thorax. We better understanding of the patterns of abnormalities seen on congratulate Drs. Christopher Walker and Jonathan Chung in the radiologic images. achieving this goal by combining their outstanding talents as editors As the editors, we were delighted with the quality of the first and their ability to obtain the collaboration of an exceptional edition and very thankful to the numerous authors who were team of internationally renowned chest radiologists to write responsible for its success. There have been, however, many major chapters in their fields of expertise. The new edition includes a changes and new developments since the publication of that truly up-to-date review of the clinical, radiologic, and pathologic edition in 2008, which led to the need for a major revision and manifestations of lung diseases and several hundred new images update. We chose to pass on the new edition to a young team that provide excellent illustrations of the latest technologic advances. of editors with the talent, energy, and dedication required in The emphasis of this book, similar to daily practice, is on planning, organizing, and completing this monumental endeavor. chest radiography and computed tomography (CT). However, We are very pleased to see that they managed to improve the as is also required in clinical practice, it includes the indications quality of the book and believe that it will be extremely useful and characteristic findings on magnetic resonance imaging and, to radiology residents, chest radiology fellows, pulmonary physi- when applicable, scintigraphy, positron emission tomography cians, thoracic surgeons, and general radiologists with an interest (PET), integrated PET-CT imaging, and ultrasound. The book in chest imaging. also provides a summary of the clinical manifestations and pathologic findings. The clinical history is always helpful and Nestor L. Müller often essential for an accurate diagnosis or appropriate differential C. Isabela Silva Müller ix PREFACE We are honored and humbled to be the editors of the second a single-volume reference. Needless to say, this was challenging, edition of Müller’s Imaging of the Chest. We are indebted to the but we are quite proud of the end product and hope you will previous editors, Drs. Nestor Müller and Isabela Silva, as well agree that essential content has not been excluded. The first part as their Associate and Assistant Editors, Drs. David Hansell, Kyung of this book deals with normal imaging appearance of the thorax Soo Lee, and Martin Rémy-Jardin, for their extraordinary work on chest radiography and CT with detailed discussions of thoracic in directing and creating the first edition of this textbook and anatomy. Truly, one does not know what abnormal is until one organizing a team of some of the most esteemed chest radiologists. knows what normal is. The second part of this book approaches The authoritative and comprehensive content in the first edition thoracic imaging from the “findings” aspect rather than from of Imaging of the Chest made it the clear gold standard reference the diagnosis side. This is likely most relevant to readers of this in thoracic imaging. When we were first offered the opportunity textbook, given that this is how patients present: with an unknown to edit this textbook, we were reluctant because the first edition diagnosis but with abnormalities on chest imaging. Finally, the was a hard act to follow. However, the opportunity to have a third part is arranged in a diagnosis or diagnostic category hand in the second iteration of the textbook, which we used as approach, as is typical of most textbooks. our personal go-to reference, was too hard to turn down. Thank- Specific highlights include updates on lung cancer screening fully, our wives urged us to take on this project lest we and an updated review of pulmonary fibrosis and interstitial lung kick ourselves in the future. Given the daunting task of updating disease management and diagnosis. In addition, four new chapters and editing the authoritative content assembled by the previous were created to more fully include topics pertinent to chest imagers: world-class team of chest radiologists, we knew we would Leukemia, Idiopathic Pleuroparenchymal Fibroelastosis, Interstitial need help. Our associate editors, Drs. Stephen Hobbs, Brent Pneumonia with Autoimmune Features, and Noninfectious Lung Little, and Carol Wu, were all obvious choices to help us and Stem Cell Transplantation Complications. direct this endeavor given their superior clinical training, unique This book would not have been possible without the support clinical backgrounds, and complementary clinical and academic of our colleagues and mentors. We thank, first, all our mentors interests. at the University of Washington and the Massachusetts General Chest radiography continues to be the most commonly Hospital for cultivating our passion for cardiopulmonary imaging obtained imaging study throughout the world. In many patients, and guiding us in the gauntlet of academic radiology; second, a high-quality chest radiograph, combined with appropriate specific leaders in the field, including Drs. David A. Lynch and clinical information, allows for accurate diagnosis. However, in J. David Godwin, whom we had the pleasure of working with many cases, it is helpful to obtain chest computed tomography and who continually provided their support and advice on all (CT) imaging given its higher contrast resolution. In recent years, matters; and third, our trainees, who have always kept us honest the line between high-resolution CT of the chest and standard in regard to what we knew (or thought we knew). We hope you CT has blurred as volumetric helical CT acquisition becomes enjoy reading this textbook (although based on your track record, the norm, allowing for reconstruction of images in any plane we assume you will get around to it next rotation). Finally, we and in virtually any slice thickness. Contrast-enhanced chest CT thank the wonderful staff at Elsevier who have made this endeavor and chest CT angiography are highly valuable tools in the assess- possible, including but not limited to Robin Carter, Ann Anderson, ment of suspected malignancy, vascular abnormalities, and Claire Kramer, and Margaret Nelson. thromboembolic disease. Magnetic resonance imaging (MRI) This book is aimed at clinical radiologists, pulmonologists, and positron emission tomography (PET) imaging are useful trainees, and any other health care professionals interested in adjuncts in thoracic imaging, specifically in the setting of known thoracic imaging. It provides a concise but comprehensive or suspected malignancy. Although specialized centers have used overview of imaging findings of thoracic diseases. We hope that MRI and PET imaging for evaluation of nonmalignant pulmonary the second edition of Müller’s Imaging of the Chest will be a abnormalities, these are still mostly avenues for research rather valuable resource for the thoracic health care community and than accepted clinical standards. will ultimately improve patient care. In the second edition of this textbook, we aim to provide a comprehensive review of thoracic imaging while simultaneously Jonathan H. Chung, MD compressing the size of the textbook from a two-volume set to Christopher M. Walker, MD x