Chest Radiology — MCQs

Q: All are chest X-ray signs of pulmonary embolism except for which of the following?

Monod sign. ***Monod sign*** - The Monod sign, also known as the "air crescent sign" or Monod's sign, is typically seen in **pulmonary aspergilloma**, not pulmonary embolism. - It refers to a **crescent-shaped air lucency** outlining a fungal ball within a pre-existing pulmonary cavity. *Westermark's sign* - This sign refers to **oligemia (decreased vascular markings)** in the affected lung zone distal to the pulmonary embolus. - It is caused by **reduced blood flow** due to obstruction of the pulmonary artery. *Fleischner sign* - The Fleischner sign indicates **distended, dilated pulmonary arteries** in the hilum, typically unilateral, due to the presence of a large embolus. - This dilation is a result of the **increased pressure** proximal to the obstruction. *Hampton's hump* - Hampton's hump is a **wedge-shaped peripheral opacity** in the lung due to **pulmonary infarction**, a consequence of a large embolism where collateral circulation is insufficient. - It often represents an area of **hemorrhagic infarction** and is typically located adjacent to the pleura.

Q: Pruning of pulmonary arteries is seen in

Pulmonary hypertension. ***Pulmonary hypertension*** - **Pruning of pulmonary arteries** refers to the visible reduction in the number and size of peripheral pulmonary arterial branches, which is a characteristic radiological sign of **pulmonary hypertension** [1]. - This phenomenon is caused by remodeling and obstruction of the small pulmonary arteries, leading to increased **pulmonary vascular resistance**. *Chronic bronchitis* - While chronic bronchitis can lead to **hypoxia** and eventually pulmonary hypertension, the direct and prominent radiological sign of **pulmonary artery pruning** is primarily associated with established pulmonary hypertension rather than specifically chronic bronchitis itself. - Chronic bronchitis primarily affects the **airways**, causing mucous hypersecretion and chronic cough, rather than direct arterial remodeling visible as pruning on imaging. *Pulmonary transplant* - A pulmonary transplant is a surgical procedure to replace diseased lungs and does not inherently cause **pruning of pulmonary arteries**. In fact, a successful transplant aims to restore normal pulmonary vasculature, though complications like **rejection** could secondarily affect vascular structures [2]. *Pulmonary infections* - Pulmonary infections primarily cause **inflammation**, consolidation, or cavitation within the lung parenchyma. - They do not typically lead to the widespread, chronic remodeling and visible **pruning of pulmonary arteries** seen in pulmonary hypertension.

Q: Hypertranslucency of the lung is seen unilaterally on all except –

Resection of mammary gland. ***Resection of mammary gland*** - A **mastectomy** (resection of mammary gland) affects the **chest wall soft tissue**, not the lung parenchyma itself. - The absence of breast tissue can create an **apparent** increased lucency on chest X-ray, but this is an **extra-thoracic finding**, not true pulmonary hypertranslucency. - It does not alter lung air content, pleural space, or pulmonary vascularity—the mechanisms that cause true unilateral lung hypertranslucency. *Pneumothorax* - A **pneumothorax** involves air in the pleural space, causing lung collapse. - This creates **true unilateral hypertranslucency** with visible pleural line and absent lung markings peripherally. - Classic radiographic finding of increased lucency in the affected hemithorax. *Pulmonary artery obstruction* - **Pulmonary embolism** or other vascular obstruction causes oligemia (reduced pulmonary blood flow). - Results in **decreased vascular markings** making the affected lung appear hypertranslucent. - Known as the **Westermark sign**—a classic radiographic finding of pulmonary embolism. *Pneumonectomy* - Surgical removal of an entire lung leaves a **fluid-filled or air-filled hemithorax**. - The operated side appears **hypertranslucent** initially (if air-filled) or shows progressive opacification with fluid. - Represents true absence of pulmonary tissue and vasculature, causing unilateral hypertranslucency.

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Normal Chest Radiographic Anatomy

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Radiographic Signs in Chest Imaging

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Pulmonary Infections

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Chronic Obstructive Pulmonary Disease

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Interstitial Lung Diseases

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Pulmonary Neoplasms

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Pleural Diseases

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Mediastinal Pathology

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Congenital and Developmental Chest Anomalies

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Pulmonary Vascular Diseases

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Chest Trauma Imaging

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Post-Surgical Chest Imaging

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