Ebook Differential diagnosis in radiology (2e): Part 1

Differential Diagnosis
in

RADIOLOGY



Differential Diagnosis
in

RADIOLOGY
Second Edition
Sumeet Bhargava

MBBS DNB (Radiodiagnosis) MNAMS FICRI FCGP FIMSA

Assistant Professor
Department of Radiodiagnosis and Imaging
Subharti Medical College
Meerut, Uttar Pradesh, India
Satish K Bhargava
MD (Radiodiagnosis) MD (Radiotherapy) DMRD FICRI FIAMS FCCP FUSI FIMSA FAMS

Professor and Head
Department of Radiology and Imaging
School of Medical Sciences and Research
Sharda Hospital, Sharda University
Greater Noida, Uttar Pradesh, India
Formerly
Professor and Head

Department of Radiology and Imaging
University College of Medical Sciences (University of Delhi)
and GTB Hospital
Delhi, India

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Inquiries for bulk sales may be solicited at:
Differential Diagnosis in Radiology
First Edition: 2005
Second Edition:  2014
ISBN 978-93-5152-173-0
Printed at


Dedicated to
My loving late wife Kalpana

and my son Sumeet
whose inspiration and sacrifice have made it
possible to bring out this book



CONTRIBUTORS
Anubhav Sarikwal
Ex-Senior Resident
Department of Radiology and Imaging
University College of Medical Sciences (University of Delhi)
and GTB Hospital
Delhi, India

Ashish Verma
Assistant Professor
Department of Radiodiagnosis and Imaging
Institute of Medical Sciences
Banaras Hindu University
Varanasi, Uttar Pradesh, India

HM Kansal
Associate Professor
Department of Pulmonary Medicine
School of Medical Sciences and Research
Sharda Hospital, Sharda University
Greater Noida, Uttar Pradesh, India

Mamta Motla
Ex-Senior Resident

Department of Radiology and Imaging
University College of Medical Sciences (University of Delhi)
and GTB Hospital, Delhi, India

Nidhi Bhargava
Ex-Senior Resident
Department of Radiology and Imaging
University College of Medical Sciences (University of Delhi)
and GTB Hospital
Delhi, India


viii

Differential Diagnosis in Radiology

OP Sharma
Professor
Department of Radiodiagnosis
Institute of Medical Sciences
Banaras Hindu University
Varanasi, Uttar Pradesh, India

Pardeep Kumar
Ex-Resident
Department of Radiology and Imaging
University College of Medical Sciences (University of Delhi)
and GTB Hospital
Delhi, India

Pushpender Gupta
Department of Radiology
Wake Forest Baptist Medical Center
Bouleward, Winston-Salem, NC27157, USA

Rajeev Chaturvedi
Ex-Senior Resident
Department of Radiology and Imaging
University College of Medical Sciences (University of Delhi)
and GTB Hospital
Delhi, India

Rajul Rastogi
Consultant and Head
Yash Diagnostic Center
Yash Hospital & Research Center
Moradabad, Uttar Pradesh, India
Ex-Senior Resident
Department of Radiology and Imaging
University College of Medical Sciences (University of Delhi)
and GTB Hospital
Delhi, India


Contributors

Satish K Bhargava
Professor and Head
Department of Radiology and Imaging
School of Medical Sciences and Research

Sharda Hospital, Sharda University
Greater Noida, Uttar Pradesh, India

Shuchi Bhatt
Reader
Department of Radiology and Imaging
University College of Medical Sciences (University of Delhi)
and GTB Hospital
Delhi, India

Sumeet Bhargava
Assistant Professor
Subharti Medical College
Meerut, Uttar Pradesh, India

Vinita Rathi
Professor
Department of Radiology and Imaging
University College of Medical Sciences (University of Delhi)
and GTB Hospital
Delhi, India

ix



PREFACE TO THE SECOND EDITION
Since there was an enormous demand of the book by the residents
and radiologists from all over the country, it was thought proper to
add more illustrations to better understand the various diseases.

We are confident that the second edition will be more useful to
the residents and consulting physicians in solving day-to-day
problems, so as to arrive at a correct diagnosis.

Sumeet Bhargava
Satish K Bhargava



PREFACE TO THE FIRST EDITION
The advancement in Radiology and subspecialties over a period of
two decades has tremendously enhanced this course and indepth
knowledge of image interpretation. This is particularly true in a
developing country like ours, where still majority of radiologists
practice in broader specialty and it is not always feasible to update
the knowledge because of paucity of time and availability of
literature/newer books at all places. However, an interpretation
of any radiograph is extremely essential for a radiologist to arrive
at a correct diagnosis, keeping in view various salient features
of disease entity on various imaging modalities and to exclude
other similar looking pictures. Thus, it is more important for a
trainee radiologist and a radiologist in practice to have a book,
which should be a valuable primer and also the concise and handy
reference to use in day-to-day practice. An attempt has been made
to list out as many important conditions as possible, enumerated
their salient features and important differential diagnoses so as to
arrive at a particular diagnosis.

Sumeet Bhargava
Satish K Bhargava

ACKNOWLEDGMENTS
We are grateful to our colleagues and friends, who gave timely
support and stood solidly behind us in our joint endeavor of
bringing out this book, which was required keeping in view the
wide acceptability of the ultrasound technique.
I am thankful to Shri Jitendar P Vij (Group Chairman), Mr Ankit
Vij (Managing Director), Mr Tarun Duneja (Director-Publishing),
Ms Samina Khan (PA to the Director-Publishing) of M/s Jaypee
Brothers Medical Publishers (P) Ltd, New Delhi, India, and all the
contributors, who have always been in keen desire to work with
smiling faces and with polite voices, as a result of which this book
has seen the light of the day.



CONTENTS
1. Chest

1



1

1.1 Lesions of Thoracic Inlet
Satish K Bhargava, Rajeev Chaturvedi

1.2 Mediastinal Masses
1.3 Superior Mediastinal Masses—Differential Diagnosis
1.4 Differential Diagnosis of Anterior Mediastinal Mass
1.5 Anterior Mediastinal Mass



1.6 D/D of Posterior Mediastinal Masses

30

Shuchi Bhatt, Rajul Rastogi, Sumeet Bhargava
Satish Kumar Bhargava, Pardeep Kumar



24

Shuchi Bhatt, Sumeet Bhargava

15

Satish K Bhargava, Nidhi Bhargava

34
41

Pushpender Gupta, Satish K Bhargava

1.7 Chest Wall Abnormalities

46

Rajul Rastogi, Vinita Rathi

1.8 Superior Rib Notching

50

Shuchi Bhatt, Pardeep Kumar

1.9 Inferior Rib Notching

53

Satish K Bhargava, Nidhi Bhargava

1.10 Elevation of Diaphragm

56

Nidhi Bhargava, Shuchi Bhatt

1.11Pneumomediastinum

59

Nidhi Bhargava, Satish K Bhargava

1.12 Lung Tumors

61

Satish K Bhargava, Nidhi Bhargava

1.13 Hilar Enlargement

64

HM Kansal, Nidhi Bhargava, Satish K Bhargava

1.14 Calcification on Chest Radiograph

67

Satish K Bhargava, Nidhi Bhargava

1.15 Air-Fluid Levels on Chest X-ray

Satish K Bhargava, Nidhi Bhargava

70


xviii

Differential Diagnosis in Radiology












1.16A Cavitating Pulmonary Lesions
1.16B Mass within Cavity
1.17 Cavitating Pulmonary Lesions
1.18A Lucent Lung Lesions
Nidhi Bhargava, Shuchi Bhatt



1.19 Solitary Pulmonary Nodule

78

Nidhi Bhargava, Satish K Bhargava

1.18B Solitary Pulmonary Nodule



72

Pardeep Kumar, Rajul Rastogi, Satish K Bhargava





71

Nidhi Bhargava, Satish K Bhargava




70

Nidhi Bhargava, Satish K Bhargava

80
82

Satish K Bhargava, HM Kansal, Sumeet Bhargava

1.20 Pulmonary Edema on the Opposite Side to a Pre-existing Abnormality

92

Nidhi Bhargava, Rajul Rstogi

1.21A Miliary Shadowing

101

HM Kansal, Satish K Bhargava, Sumeet Bhargava

1.21B Miliary Shadowing (0.5 to 2 mm)

105

Satish K Bhargava, Nidhi Bhargava, Sumeet Bhargava

1.22 Multiple Pinpoint Opacities

107

Sumeet Bhargava, Nidhi Bhargava, Shuchi Bhatt

1.23 Complete Opaque Hemithorax

109

Nidhi Bhargava, Vinita Rathi

1.24 Opaque Hemithorax

111

Satish K Bhargava, Pushpender Gupta, HM Kansal

1.25 Hypertransradiant Lung Field

114

Sumeet Bhargava, Satish K Bhargava, Anubhav Sarikwal

1.26 Hypertranslucent Lung Field

121

Nidhi Bhargava, Sumeet Bhargava

1.27A Honeycomb Lung

122

Sumeet Bhargava, Nidhi Bhargava, Satish K Bhargava

1.27B Honeycomb Pattern

125

Satish K Bhargava, Vinita Rathi, Sumeet Bhargava

1.28 Pleural Diseases
Rajul Rastogi, Sumeet Bhargava

128


xix

Contents









1.29 Pleural Fluid
1.30 Pleural Tumors
1.31 Pleural Calcification

139

Sumeet Bhargava, HM Kansal, Rajeev Chaturvedi, Satish K Bhargava

1.32 High Resolution CT-Pattern of Parenchymal Disease

Nidhi Bhargava, Rajul Rastogi, Satish K Bhargava



137

Nidhi Bhargava, Sumeet Bhargava, Satish K Bhargava




136

Shuchi Bhatt, Nidhi Bhargava

1.33 Cardiophrenic Angle Mass

141
142

Sumeet Bhargava, Satish K Bhargava, HM Kansal

2. Breast—Mammographic Differential Diagnosis

148

148



Sumeet Bhargava, Rajul Rastogi, Satish K Bhargava, Pushpender Gupta

2.1 Circumscribed Radiolucent Lesion

3. Cardiovascular System

170



170





3.1 Differential Diagnosis of Cardiovascular Disorders
Sumeet Bhargava, Satish K Bhargava, Rajul Rastogi

3.2 Invisible Main Pulmonary Artery



Sumeet Bhargava, Satish K Bhargava

3.3 Pulmonary Arterial Hypertension



Sumeet Bhargava, Satish K Bhargava






















3.4 Enlarged Left Ventricle (ELV)

171
174
176

Sumeet Bhargava, Satish K Bhargava

3.5 Enlarged Left Atrium

180

Rajul Rastogi, Satish K Bhargava, Sumeet Bhargava

3.6 Dilatation of Pulmonary Trunk

183

Rajul Rastogi, Satish K Bhargava, Sumeet Bhargava

3.7 Enlargement Aorta

184

Sumeet Bhargava, Satish K Bhargava

3.8 Small Aorta

185

Sumeet Bhargava, Satish K Bhargava

3.9 Enlarged Right Atrium

186

Sumeet Bhargava, Satish K Bhargava

3.10 Enlarged Right Ventricle
Sumeet Bhargava, Satish K Bhargava

188


xx

Differential Diagnosis in Radiology


3.11 Right Aortic Arch





3.12 Pulmonary Venous Hypertension





3.13 Enlarged Superior Vena Cava

3.14 Cardiac Calcifications
3.15 Cardiac Valve Calcifications
3.16Situs

197

Sumeet Bhargava, Satish K Bhargava

3.17 Cyanotic Heart Disease



197

Sumeet Bhargava, Satish K Bhargava

4. Soft Tissue Lesions











196

Sumeet Bhargava, Satish K Bhargava





195

Sumeet Bhargava, Satish K Bhargava





194

Sumeet Bhargava, Satish K Bhargava





193

Rajul Rastogi, Satish K Bhargava, Sumeet Bhargava

191

Rajul Rastogi, Satish K Bhargava, Sumeet Bhargava

200

Sumeet Bhargava, Satish K Bhargava, Shuchi Bhatt

4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8

Differential Diagnosis of Soft Tissue Lesions
Soft Tissue Ossification
Linear Calcification of Soft Tissues
Parasitic Calcification
Areas of Decreased Density
Periarticular Soft Tissue Calcification
Generalized Calcinosis
Sheet-like Calcification in Soft Tissue

200
201
203
207

210
211
213
214

5. Abdomen and Gastrointestinal Tract and Hepatobiliary System 215





5.1 Dilated Esophagus
5.2 Esophageal Carcinoma



Rajul Rastogi, Rajeev Chaturvedi, Satish K Bhargava



5.3 Thickened Mucosal Folds—Esophagus and Stomach






215

Rajul Rastogi, Satish K Bhargava, Rajeev Chaturvedi

221
227

Ashish Verma, Shuchi Bhatt, Sumeet Bhargava

5.4 Thickened Gastric Folds
Rajul Rastogi, Satish K Bhargava, Sumeet Bhargava

244


xxi

Contents

5.5 Thickened Duodenal Folds
5.6 Massively Dilated Stomach
5.7 Target Lesions in Stomach on Barium Studies
5.8 Gas in Gastric Wall
5.9 Cobblestone Duodenal Cap on Barium Study




5.10 Dilated Duodenum/Obstruction of Duodenum

5.12 Strictures Small Bowel
5.13 Small Intestinal Stricture
5.14 Thickened Folds in Small Bowel

255
262

Rajul Rastogi, Shuchi Bhatt, Sumeet Bhargava
Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava



254

Anubhav Sarikwal, Sumeet Bhargava

5.15 Thickened Small Bowel Folds with Gastric Abnormality



253

Rajul Rastogi, Satish K Bhargava




251

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

250

Satish K Bhargava, Rajul Rastogi, Sumeet Bhargava

Rajul Rastogi, Shuchi Bhatt, Sumeet Bhargava



249

Satish K Bhargava, Rajul Rastogi, Sumeet Bhargava

5.11 Dilated Small Bowel/Jejunal and Ileal Obstruction



248

Sumeet Bhargava, Satish K Bhargava, Rajul Rastogi




247

Satish K Bhargava, Rajul Rastogi, Sumeet Bhargava

246

Rajul Rastogi, Satish K Bhargava, Sumeet Bhargava

5.16 Nodular Appearance of Small Bowel

264
264

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

5.17Malabsorption

266

Satish K Bhargava, Rajul Rastogi, Sumeet Bhargava

5.18Malabsorption

266

Sumeet Bhargava, Pushpender Gupta, Shuchi Bhatt

5.19 Protein Losing Enteropathy

276

Satish K Bhargava, Rajul Rastogi, Sumeet Bhargava

5.20 Pathologic Lesions in Terminal Ileum

276

Satish K Bhargava, Rajul Rastogi, Sumeet Bhargava

5.21 Colonic Polyps
Satish K Bhargava, Rajul Rastogi, Sumeet Bhargava

278


xxii

Differential Diagnosis in Radiology

5.22 Colonic Polyps
5.23 Colonic Strictures/Narrowing
5.24 Pneumatosis Intestinalis
5.25 Megacolon in Adults
5.26 Thumb Printing in Colon
5.27 Aphthous Ulcers
5.28 Anterior Indentation of Rectosigmoid Junction
Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava



5.29 Widening/Enlargement of Presacral/Retrorectal Space



Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

5.30 Cystic Mesenteric Masses



Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava



5.31 Nonvisualization of Gallbladder on Ultrasound

288

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava





287

Rajul Rastogi, Satish K Bhargava

285

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava



284

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava





281

Sumeet Bhargava, Satish K Bhargava

289
290
290
291
292

Rajul Rastogi, Sumeet Bhargava

5.32 Gas in Biliary Tree

293

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

5.33 Gas in Portal Venous

294

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

5.34 Diffuse Hepatomegaly

295

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

5.35 Hepatic Calcification

296

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

5.36 Primary Hepatic Masses

298

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

5.37 Neonatal Obstructive Jaundice

300

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

5.38 Fetal/Neonatal Hepatic Calcification
Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

301


xxiii

Contents






5.39 Diffusely Hypoechoic Liver
5.40 Diffusely Hyperechoic Liver (Bright Liver)
5.41 Focal, Hyperechoic, Hepatic Lesions



Rajul Rastogi, Satish K Bhargava

5.42 Focal, Hypoechoic, Hepatic Lesions

302

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava




302

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

303
303

Sumeet Bhargava, Satish K Bhargava, Rajul Rastogi

5.43 Periportal Hyperechogenicity

303

Sumeet Bhargava, Satish K Bhargava, Rajul Rastogi

5.44 Thickened Gallbladder Wall

304

Sumeet Bhargava, Satish K Bhargava, Rajul Rastogi

5.45 Focal Hypodense Lesions on NECT Liver

305

Satish K Bhargava, Sumeet Bhargava, Rajul Rastogi

5.46 Hyperperfusion Abnormalities of Liver

306

Satish K Bhargava, Rajul Rastogi, Sumeet Bhargava

5.47 Hepatic Tumors with Vascular “SCAR”307
Satish K Bhargava, Rajul Rastogi, Sumeet Bhargava

5.48 Diffusely Hypodense Liver on NECT307
Satish K Bhargava, Rajul Rastogi, Sumeet Bhargava

5.49Splenomegaly

308

Sumeet Bhargava

5.50 Splenic Calcification

308

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

5.51 Hyperechoic Splenic Lesion

309

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

5.52 Focal Hypoattenuating Lesions in Spleen

309

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

5.53 Pancreatic Calcification

310

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

5.54 Pancreatic Masses

311

Satish K Bhargava, Pushpender Gupta, Pardeep Kumar

5.55 Focal Pancreatic Masses
Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

316


xxiv

Differential Diagnosis in Radiology

5.56 Adrenal Mass
5.57 Adrenal Calcification
5.58 Extraluminal Intra-abdominal Gas
5.59Pneumoperitoneum
5.60Pneumoperitoneum

323

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

5.61 Gasless Abdomen

326

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

5.62Ascites

327

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava
Rajul Rastogi, Sumeet Bhargava



320

Sumeet Bhargava, Anubhav Sarikwal, Shuchi Bhatt

5.63 Abdominal Mass in Neonates



319

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava




318

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava




317

Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

5.64 Abdominal Mass in Child

330
331

Sumeet Bhargava, Satish K Bhargava, Rajul Rastogi

5.65 Intestinal Obstruction in Neonates

333

Sumeet Bhargava, Rajul Rastogi, Satish K Bhargava

5.66 Abnormalities of Bowel Rotation

334

Sumeet Bhargava, Rajul Rastogi, Satish K Bhargava

5.67 Intra-abdominal Calcification in Neonates

336

Sumeet Bhargava, Rajul Rastogi, Satish K Bhargava

5.68Hematemesis

337

Sumeet Bhargava, Satish K Bhargava, Rajul Rastogi

5.69 Dysphagia in Adults

339

Sumeet Bhargava, Satish K Bhargava, Rajul Rastogi

5.70 Neonatal Dysphagia

340

Sumeet Bhargava, Satish K Bhargava, Rajul Rastogi

5.71 Pharyngeal/Esophageal Diverticula

341

Sumeet Bhargava, Satish K Bhargava, Rajul Rastogi

5.72 Esophagitis/Esophageal Ulcers
Rajul Rastogi, Sumeet Bhargava, Satish K Bhargava

342