Chest Radiology Practice Questions

Q: The CXR given shows presence of:

Hydropneumothorax. ***Hydropneumothorax*** - The image clearly shows a **horizontal air-fluid level** within the pleural cavity on the right side. This distinct level indicates the presence of both **fluid (hydro)** and **air (pneumo)**. - The **collapsed lung** due to the presence of air and fluid is also visible, confirming the diagnosis. *Pleural effusion* - A pleural effusion would typically present with a **meniscus sign** (curvilinear upper border) rather than a straight horizontal air-fluid level. - While fluid is present, the presence of **air** is also evident and crucial for distinguishing it from a simple effusion. *Lung abscess* - A lung abscess is an **intraparenchymal collection of pus** within the lung tissue. - It would typically appear as a thick-walled cavity with an **air-fluid level inside the lung parenchyma**, not in the pleural space. *Collapse* - Lung collapse (atelectasis) involves loss of volume in part or all of a lung, often presenting as **increased opacification** and displacement of structures towards the collapsed side. - Although the lung is collapsed in this image, it is a *consequence* of the hydropneumothorax, not the primary finding on its own, and doesn't explain the distinct air-fluid level.

Q: Which lung disease is shown in the image below marked as X?

Interstitial fibrosis. ***Interstitial fibrosis*** - The curve labeled 'X' shows a **lower lung volume for a given transpulmonary pressure** compared to the 'Normal' curve, indicating **decreased lung compliance**. - A decrease in lung compliance and **reduced total lung capacity (TLC)** are hallmarks of **restrictive lung diseases** like interstitial fibrosis, where the lungs become stiff and difficult to inflate. *Emphysema* - Emphysema is an **obstructive lung disease** characterized by **increased lung compliance** and **increased total lung capacity (TLC)** due to the destruction of elastic tissue. - Its curve would be shifted to the left and up compared to normal, indicating a larger volume for a given transpulmonary pressure, which is opposite to what is shown for 'X'. *Asthma* - Asthma is also an **obstructive lung disease** primarily affecting airflow due to **bronchoconstriction** and inflammation. - While lung compliance may be slightly altered, the hallmark features of the pressure-volume curve in asthma typically involve air trapping and often a **normal or increased TLC** during an exacerbation, not a significantly reduced TLC and decreased compliance as shown. *Normal* - The curve labeled 'Normal' represents typical lung compliance, where lung volume increases appropriately with transpulmonary pressure. - Curve 'X' clearly deviates from this normal pattern, showing a **reduced capacity** to expand for the same pressure.

Q: A 16-year-old boy is admitted with rapidly accumulating bilateral pleural effusion. His chest X-ray is shown below. Which of the following is incorrect about the X-ray shown?

Pneumothorax. ***Pneumothorax*** - A **pneumothorax** is characterized by the presence of **air in the pleural space**, which typically appears as a **lucent area** without lung markings and a displaced visceral pleural line on X-ray. - The presented chest X-ray shows **dense opacities at the lung bases**, consistent with fluid accumulation (**pleural effusion**), not air. *Left-sided pleural effusion* - The image clearly shows significant **opacification of the left hemithorax** with blunting of the **costophrenic angle** and obscuring of the left hemidiaphragm. - This finding is consistent with a large amount of fluid, indicating a **left-sided pleural effusion**. *Mediastinum shifted to right* - The **trachea** and **cardiac silhouette** are visibly displaced towards the **right side** of the chest. - This shift is a consequence of the large **left-sided pleural effusion exerting mass effect** and pushing the mediastinal structures away from the affected side. *Bilateral ICD tubes* - There are discernable radiopaque lines extending into both pleural spaces, representing **bilateral intercostal drainage (ICD) tubes**. - These tubes are placed to drain the **accumulated pleural fluid** from both the right and left sides.

Q: The CT chest shows presence of:

Pulmonary alveolar proteinosis. ***Pulmonary alveolar proteinosis*** - CT images of pulmonary alveolar proteinosis often show diffuse, bilateral ground-glass opacities with superimposed **interlobular and intralobular septal thickening**, creating a characteristic **crazy-paving pattern**. - This pattern, as seen in the image, is caused by the accumulation of lipoproteinaceous material within the alveoli and is a hallmark of the disease. *Interstitial lung disease* - While some forms of interstitial lung disease can cause ground-glass opacities and septal thickening, the **"crazy-paving" pattern** seen so clearly and diffusely here is not typically their most characteristic finding. - ILD often presents with **reticular opacities**, honeycombing, or traction bronchiectasis, which are less prominent or absent in this specific image. *Bronchiectasis* - Bronchiectasis is characterized by **irreversible dilation of the bronchi**, usually accompanied by wall thickening. - This condition would appear on CT as **dilated, thickened airways** (often described as "tram-track" opacities or "signet-ring" signs) and mucus plugging, which are not the predominant findings in the provided image. *Aspergillosis* - Pulmonary aspergillosis encompasses several forms, such as aspergilloma (fungus ball in a cavity), invasive aspergillosis (nodules, halo sign, or cavitation), or allergic bronchopulmonary aspergillosis (mucoid impaction, bronchiectasis). - The diffuse ground-glass opacities with septal thickening seen in the image do not typically represent the primary radiological features of aspergillosis.

Q: The image provided represents:

CT chest without contrast. ***CT chest without contrast*** - The image displays detailed **cross-sectional anatomy** of the chest, including the lungs, mediastinum, and cardiac structures, without any evident enhancement of blood vessels or organs. - The varying **grayscale densities** accurately depict different tissue types (e.g., air in lungs as black, bone as white, soft tissues as shades of gray) as expected in an **unenhanced CT scan**. - The **cross-sectional detail** and high resolution are characteristic of a **CT scan**. *Barium swallow study* - The image provided is a **CT scan of the chest**, not a barium swallow study. A barium swallow study involves administering barium contrast and taking X-rays to visualize the esophagus. - The density and grayscale variations seen in the image are characteristic of a CT, which uses X-rays to create cross-sectional images of body structures, and not of the high-contrast white appearance of barium within an organ lumen. *CT chest with contrast* - This image does not demonstrate enhancements of vascular structures or organs typically associated with the administration of **intravenous contrast material**. - Without the presence of **hyperdense (bright) opacification of blood vessels** (like the aorta or pulmonary arteries) or soft tissues, it is less likely to be a contrast-enhanced study. *X-ray chest* - While an X-ray chest is used to visualize chest structures, this image exhibits **cross-sectional detail** and high resolution that is characteristic of a **CT scan**, rather than a plain film X-ray. - An X-ray chest provides a 2D projection, whereas this image clearly shows a 3D cut through the chest organs with distinct tissue densities.

Q: The image shows presence of:

Hydropneumothorax. ***Hydropneumothorax*** - The image shows both **air and fluid levels in the pleural cavity**, indicating a hydropneumothorax. The distinct straight line separating air and fluid is characteristic. - Presence of **air (lucency)** in the superior part of the pleural space and **fluid (opacity)** forming a horizontal line below it confirms this diagnosis. *Pleural effusion* - A pleural effusion would appear as a **homogenous opacity** in the dependent portion of the pleural space, typically blunting the costophrenic angles. - It would not exhibit a distinct **air-fluid level** within the pleural cavity without an associated pneumothorax. *Pneumothorax* - A pneumothorax presents as **air in the pleural space** without fluid, resulting in increased lucency and collapse of lung tissue. - There would be **no fluid level visible**, only air separating the parietal and visceral pleura. *Pneumonia* - Pneumonia would appear as an **area of consolidation** within the lung parenchyma, often ill-defined, and without a clear air-fluid level in the pleural space. - It involves the lung tissue itself, not primarily the pleural space, and would typically present with **air bronchograms** within the consolidated area.

Q: The CT chest of a patient shows:

Ground glass pattern. ***Ground glass pattern*** - The CT scan shows diffuse hazy opacities that do not obscure the underlying bronchial and vascular markings, which is characteristic of a **ground-glass pattern**. - This pattern indicates a partial filling of airspaces, interstitial thickening, or a combination of both, often seen in conditions like **pneumonitis** or early acute respiratory distress syndrome. *Honeycomb pattern* - The image does not display the characteristic **thick-walled cystic airspaces** seen in a honeycomb pattern, which typically represents end-stage pulmonary fibrosis. - While there is some architectural distortion, it lacks the discrete, clustered cysts with clearly defined walls that define true honeycombing. *Crazy pavement pattern* - The crazy paving pattern is characterized by **ground-glass opacities superimposed with interlobular septal thickening**, which is not clearly and extensively demonstrated in this scan. - While some ground-glass is present, prominent septal thickening creating a polygonal pattern is not the predominant feature. *Normal scan* - The scan clearly shows widespread **abnormal opacities** throughout both lungs, indicating significant underlying pathology. - A normal chest CT would show uniform lung parenchyma with clear bronchial and vascular markings without any significant areas of increased attenuation.

Q: The CXR shows markings near the costophrenic angle. Which of the following is the cause of these markings? (Recent NEET Pattern 2016-17)

Lymphangitis carcinomatosis. ***Lymphangitis carcinomatosis*** - The image shows **reticulonodular interstitial markings** with preserved lung volumes, particularly prominent near the costophrenic angle, which are classic for **lymphangitis carcinomatosis**. - This condition is caused by the infiltration of **malignant cells into the lymphatic channels** of the lung, leading to thickening of the interlobular septa and a characteristic radiographic appearance. *Pulmonary alveolar proteinosis* - This condition typically presents with diffuse ground-glass opacities and consolidation, often described as a **"crazy-paving" pattern** on CT, which is not seen here. - It involves the accumulation of lipoproteinaceous material within the **alveoli**, rather than lymphatic infiltration. *Lung abscess* - A lung abscess would appear as a **cavitated lesion** with an air-fluid level, indicating necrosis and fluid accumulation, which is distinctly different from the interstitial markings in the image. - It is typically caused by **bacterial infection** and is a focal process, not diffuse interstitial infiltration. *Pneumatocele* - A pneumatocele is a **thin-walled, air-filled cyst** commonly seen after pneumonia in children or trauma, appearing as a clear, defined space on imaging. - It does not present with the diffuse reticulonodular pattern or interstitial thickening characteristic of the image.

Q: A 65-year-old hypertension patient presents with chest pain, difficulty in breathing for 1 hour. Based on the chest X-ray shown below, identify the radiological finding:

Kerley B lines. ***Kerley B lines*** - The chest X-ray in a patient with acute **cardiac decompensation** and **pulmonary edema** often shows **thickened interlobular septa**, known as Kerley B lines, which are short, horizontal lines seen in the lung periphery. - These lines are indicative of **interstitial pulmonary edema**, which is highly consistent with a patient presenting with acute chest pain and difficulty breathing, especially with a history of hypertension, suggesting acute heart failure. *Widened mediastinum* - A **widened mediastinum** on chest X-ray is a classic radiological finding suggestive of **aortic dissection**, which can cause chest pain in a hypertensive patient. - However, the clinical presentation with acute heart failure symptoms and the presence of **Kerley B lines** point toward pulmonary edema rather than aortic pathology. - Widened mediastinum is not associated with Kerley B lines. *Hilar lymphadenopathy* - **Hilar lymphadenopathy** appears as enlarged lymph nodes around the hilum of the lungs, indicating conditions like sarcoidosis, tuberculosis, or malignancy. - It would not typically be an acute finding in a patient presenting with acute chest pain and difficulty breathing due to hypertension, nor would it cause Kerley B lines. *Pneumomediastinum* - **Pneumomediastinum** is characterized by the presence of air in the mediastinum, visible on a chest X-ray as a **lucent streak** outlining mediastinal structures (e.g., heart borders, aorta). - This condition does not typically present with Kerley B lines and is usually associated with symptoms like retrosternal chest pain that can radiate to the neck, dyspnea, and subcutaneous emphysema, which are different from the presented clinical picture.

Question 1

The CXR given shows presence of:

Accepted Answer

Hydropneumothorax

Answer

Pleural effusion

Answer

Lung abscess

Answer

Collapse

Question 2

Which lung disease is shown in the image below marked as X?

Accepted Answer

Interstitial fibrosis

Answer

Emphysema

Answer

Asthma

Answer

Normal

Question 3

A 16-year-old boy is admitted with rapidly accumulating bilateral pleural effusion. His chest X-ray is shown below. Which of the following is incorrect about the X-ray shown?

Accepted Answer

Pneumothorax

Answer

Left-sided pleural effusion

Answer

Mediastinum shifted to right

Answer

Bilateral ICD tubes

Question 4

The CT chest shows presence of:

Accepted Answer

Pulmonary alveolar proteinosis

Answer

Interstitial lung disease

Answer

Bronchiectasis

Answer

Aspergillosis

Question 5

The image provided represents:

Accepted Answer

CT chest without contrast

Answer

Barium swallow study

Answer

CT chest with contrast

Answer

X-ray chest

Question 6

The image shows presence of:

Accepted Answer

Hydropneumothorax

Answer

Pleural effusion

Answer

Pneumothorax

Answer

Pneumonia

Question 7

The CT chest of a patient shows:

Accepted Answer

Ground glass pattern

Answer

Honeycomb pattern

Answer

Crazy pavement pattern

Answer

Normal scan

Question 8

The CXR shows markings near the costophrenic angle. Which of the following is the cause of these markings? (Recent NEET Pattern 2016-17)

Accepted Answer

Lymphangitis carcinomatosis

Answer

Pulmonary alveolar proteinosis

Answer

Lung abscess

Answer

Pneumatocele

Question 9

Chest X-ray was performed on a patient with malar flush and effort intolerance. All are true about the condition shown in the figure except:

Accepted Answer

Presystolic accentuation becomes louder with atrial fibrillation

Answer

Straightening of left heart border

Answer

Pressure half-time is used to assess severity on Doppler

Answer

Pulmonary apoplexy

Question 10

A 65-year-old hypertension patient presents with chest pain, difficulty in breathing for 1 hour. Based on the chest X-ray shown below, identify the radiological finding:

Accepted Answer

Kerley B lines

Answer

Widened mediastinum

Answer

Hilar lymphadenopathy

Answer

Pneumomediastinum

Chest Radiology — MCQs

Chest Radiology — MCQs

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