These exercises are meant for students and practitioners who wish to familiarize themselves with the normal and pathologieal computerized tomographie radioanatomy of the abdomen. The iconography is suffieiently characteristic to be read without the help of clinical or biological data. It comprises both normal and pathologie findings. Analysis of scans is comprised of two steps. The first part consists of the detailed study of normal scans, whieh serve as a reference. For this, eight main slice levels have been considered necessary and sufficient: neces sary since a certain number of slices are indispensable for the exploration of the abdomen; sufficient because a larger number of slices would risk rendering memorization difficult. The second part involves a study of the pathologie findings, organ by organ. Acknowledgements. Appreciation is extended to all those who have helped in realizing this study and, more particularly, to our friends and colleagues, J. L. DIETEMANN, C. Roy, J. L. BURGUET, M. VOUGE, and J. W. SOUITER. We would also like to thank Dr. J. WIECZOREK for his friendly assistance and advice in the planning and presentation of figures and schemata. 1 Technical Note Computerized tomography of the abdomen begins with an initial image called "scout view". This numbered radio graph of the abdomen is an analogous representation of the information and allows the location of the eight selected slice levels; these are represented by horizontallines. The slices are 10 mm thick and are taken at intervals of 2.5 cm.

Like my first book of exercises in radiological diagnosis con- cerning the vertebrae in adults, the first part of this book consists of an atlas of images ready for immanent reading. The images are numbered, each number corresponding to a case. The second part comprises the corresponding comments, critical interpretations, and drawings (using the same num- bers as the corresponding radiographs in the first part). I hope that this second booklet will be as appreciated as was the first, which was published in four languages (Radio- diagnosis of the Vertebrae in Adults. Springer, Berlin Hei- delberg New York 1983). My own documentation having proved deficient in some fields, I had recourse to the didactic collections oimy collea- gues, friends, and students. Special thanks are due to Prof. J. F. Bonneville, and to Drs. J. L. Dietemann, Y. Dirheimer, J. C. Dosch, and J. Vignaud. AUGUSTE WACKENHEIM VII Contents Introduction ...1 Part One: Iconography 5 Part Two: Commentary with Corresponding Schemata. 107 References . . 189 Subject Index 191 IX Introduction The analysis or the reading of an X-ray picture proceeds from struc- turalistic rules, such as the immanence, the synchronism, the significa- tion (signifiant and signifie of a sign), first from the semeiologic and then from the semantic point of view. In a simpler way, one can say that it is necessary to distinguish the signifiant, the signiGBPie, the comment, the interpretation, and the radiobioclinical confrontation. The signifiant or character is a normal or pathological "characteris- tic" part of the image.

This book is intended for beginners and for those who want to refresh their knowledge of the elementary radioanatomy of the vertebrae, particularly their pathological radioanatomy. I do not pretend, as does Roger Martin du Gard's hero, that one always must begin with a radiographic examination, but I do believe that a student, especially one interested in radiology, must be able to apprehend an image isolated from its clinical context. To optimize memorization of the image I have selected unmistakable cases with marked, well-evolved lesions. This will enable the studentlater to recognize less distinct images of the same kind. The first section of the book is exclusively iconographic. After studying an image, the reader will find in the second section, under the appropriate reference number, a commen tary illustrated with a realistic drawing by my friend Dr. Csaba Hethalmi. Attention to the following points will assist a fruitful reading: 1. Cases 1-5 involve normal subjects; all other cases are pathological. 2. The reader must imagine that he is conducting a routine examination and draw on his resources to make a practical analysis of an image. As a matter of fact, all the films (except that in case 46, which is the radiograph of a specimen) were -indeed taken under routine conditions using standard pro jections. 3. The cases are in no systematic or nosological order. Each case is illustrated with one, two, or (rarely) three images.

Dieses Aoebungsbuch richtet sich an Studenten, A"rzte und Radiologen, die sich mit der Auswertung von Computertomogrammen des Abdomens vertraut machen wollen. Die einzelnen FAlle zeigen zum einen Kontrollaufnahmen des Gesunden und zum anderen pathologische VerAnderungen, die organspezifisch klassifiziert sind. Der Leser wird im vorliegenden Band schrittweise an die systematische Interpretation der Computertomogramme herangefA1/4hrt.

Wie in unserem ersten Ubungsbuch zur Rontgendiagnostik der Wirbel des Erwachsenen, wird es hier zwei verschiedene Teile geben. Der erste Teil besteht nur aus Bildern, die immanent gelesen werden sollen. Die Bilder sind laufend numeriert; jede Nummer entspricht einem Fall. 1m zweiten Teil geben wir Kommentare, kritische Interpre tationen und Skizzen dieser Bilder unter den entsprechenden Nummern. Ich wiinsche diesem zweiten Biichlein den gleichen Erfolg wie dem ersten, das in 4 Sprachen erschienen ist. Da meine eigene lkonographie manchmal unvollsHindig war, habe ich auf die Lehrsammlungen meiner Kollegen, Freunde und SchUler zuriickgegriffen. Ich mochte hier den Herren Prof. Dr. J. F. Bonneville, Dr. J. L. Dietemann, Dr. Y. Dirheimer, Dr. J. C. Dosch und Dr. J. Vignaud fur ihre freundliche Mitarbeit herzlich danken. AUGUSTE W ACKENHEIM VII Inhaltsverzeichnis Einleitung ...... 1 1. Teil: R6ntgenbilder 5 2. Teil: Text und Schemata 107 Literaturverzeichnis 189 Sachverzeichnis 191 IX Einieitung Beim Lesen eines R6ntgenbildes mussen wir strukturalistische Regeln wie Immanenz, Synchronie, Signifikant und Signifikat eines Zeichens, berucksichtigen und uns zuerst in der Semiologie bewegen und dann in der Semantik. Vereinfacht k6nnte man sagen, daB wir folgende Begriffe zu unter scheiden haben: der Signifikant, das Signifikat des Zeichens, der Kommentar, die Interpretation und die radio-bio-klinische Gegenuber stellung. Der Signifikant, auch Charakter genannt, ist ein charakteristischer Bildteil (normal oder pathologisch). Beispiel: Sella turcica, Crista galli, Fraktur, Osteom, Aneurysma. Das Signifikat ist normal, spezifisch fUr eine Krankheitsgruppe oder pathognomonisch fur eine bestimmte Krankheit. Beispiel: normal: in diesem Fall sind Signifikant und Signifikat identisch."

Der Schwerpunkt dieses Buches liegt auf dem Erkennen und der Interpretation r-ntgenologischer Zeichen. Der Leser soll da- durch in die Lage versetzt werden, die Bildsprache einer R-ntgenaufnahme zu erkennen. Die r-ntgenologischen Zeichen werden jeweils in einem dreistufigen Informationsgang vorge- stellt. Die Autoren stellen jeweils die charakteristischen, die spezifischen und die pathognomonischen Zeichen vor und geben ihre diagnostische Wertigkeit an.

In the beginning after Dandy's publication in 1918, ventriculo- graphy and pneumencephalography were the main tools in the neuroradiographical examination of brain tumours. Later on, cerebral angiography after Egaz Moniz in 1927, has been more and more commonly used. Now it appears to be the most important neuroradiological examination in tumours of the great hemispheres. Up till some years ago, air studies were the predominant examinations in lesions of the brainstem and the contents of the posterior fossa. Gradually angiographic examination for lesions in these regions has been more frequently used. Nowadays angiographic examination of the mesencephalon proves to be of increasing importance. However, some neuro- radiologists feel inhibited. They fear difficulties when reading the angiogram, even if the subtraction method is applied. Like other workers in the field of neuroradiology and neuro- surgery they will be very pleased with the edition of Wacken- heim and Braun's monograph. These authors are already well known because of their excellent air studies in mesencephalic lesions. With this book they provide us with a most valuable and clear guide to the inter- pretation of normal and pathologic angiograms, including capillarograms, of the mesencephalic regions.