Atlas of Gray Scale Ultrasonography

It has been just five years since gray-scale ultrasound (U/S) became clinically available. Yet the day-to-day importance of U/S in general medicine and surgerynot just the traditional areas of ob/gyn and echocardiography-would be hard to overestimate. Because U/S is so new, however, there are still many clinicians who are ill at ease with those funny fuzzy speckled images, so different from the familiar roentgenogram. For them and for all who wish to take full advantage of ultrasound's burgeoning capabilities, Kenneth J.W. Taylor's new book is a boon. An explanation of the physics and technology of ultrasound opens the book: types of tissue "reflectors," determinants of resolution, modes of scanning. This is followed by some practical hints on how to obtain technically adequate scans; this is important because U/S depends much more than does roentgenology on the skill of the operator. The rest of the book, arranged by anatomic location, illustrates first normal U/S anatomy and then representative abnormalities ranging from the common (liver tumors, gallstones, pancreatic pseudocysts, renal masses, aneurysms) to the exotic (retroperitoneal lymphangiomyomatosis, pheochromocytoma). Each entity is illustrated by one or more scans together with a labeled sketch showing how the scan is to be interpreted, as well as text giving the clinical history and comments. Illustrations also include isotope scans and radiologic contrast studies to show their relationship to the ultrasonograms in clarifying the diagnosis. After reviewing some of these fascinating cases, the reader quickly learns to recognize familiar U / S landmarks. It is exciting to discover that normally obscure structures such as the pancreas and mesenteric vessels become plainly visible. One learns how to discriminate between cirrhosis and fatty liver, to recognize the typical appearance of pancreatitis and pancreatic carcinoma, to see hydronephrosis and renal transplant rejection. The chapters on obstetrics and gynecology are quite complete. There are also sections on the spleen, the thyroid, and the thorax (but not the heart). There are not many things to complain about. Occasional editorial lapses such as unexplained symbols are not really troublesome. The text at times starts to sound like a polemic for ultrasound, but the author is quite careful to state the method's limitations. He presents, for example, a list of guidelines for when it is appropriate to order an U/S scan of the liver and upper abdomen and compares it candidly with CAT scanning and other modalities. The scans themselves are the best testimonial to ultrasound's great usefulness (due in large part to author Taylor's own fundamental contributions). This superb book will be a valuable addition to any clinician's library.