Chest Radiology Practice Questions

Q: A patient presented with sudden onset difficulty in breathing with RR 28/min, normal blood pressure. X-ray was taken which is given below. What is the diagnosis?

Hydro-pneumothorax. ***Hydro-pneumothorax*** - The chest X-ray clearly shows a **horizontal air-fluid level** in the right hemithorax, indicating the presence of both air (pneumothorax) and fluid (hydrothorax) within the pleural space. - The patient's sudden onset **difficulty in breathing** and **tachypnea (RR 28/min)** are consistent with significant lung pathology like a hydropneumothorax, which compromises lung function. *Pneumothorax* - A simple pneumothorax would show only **air in the pleural space**, characterized by a visible visceral pleural line and absence of lung markings beyond it. - While there is air present, the prominent **fluid level** rules out a diagnosis of pneumothorax alone. *Pleural effusion* - Pleural effusion presents as a **blunting of the costophrenic angles** and a meniscus sign, where fluid conforms to the shape of the thorax. - This image shows a **straight air-fluid level**, not a typical meniscus, indicating the presence of air in addition to fluid. *Consolidation* - Consolidation refers to the **filling of alveolar spaces with fluid or exudate**, appearing as an opacification within the lung parenchyma. - Consolidations typically do not present with a **horizontal fluid level** in the pleural space; they are intraparenchymal.

Q: Curve A signifies which of the following?

(a). ***Option (a) - Emphysema (Curve A is correct)*** - Curve A shows a **leftward shift** compared to the normal curve on the pressure-volume diagram - For any given transpulmonary pressure, a **higher lung volume** is achieved - This indicates **increased lung compliance** - the lungs are easier to inflate - Characteristic of **emphysema**, where there is **loss of elastic recoil** due to destruction of alveolar walls and elastic tissue - In emphysema, lungs inflate easily but have difficulty deflating due to loss of elastic recoil *Option (b) - Normal* - This would represent the **baseline normal pressure-volume curve** - Serves as a reference point to compare pathological states - Shows normal lung compliance and elastic recoil *Option (c) - Pulmonary Fibrosis* - This would show a **rightward shift** on the pressure-volume curve - For any given transpulmonary pressure, a **lower lung volume** is achieved - Indicates **decreased lung compliance** - the lungs are stiffer and harder to inflate - Characteristic of **restrictive lung diseases** like pulmonary fibrosis, where excessive collagen deposition makes lungs stiff *Option (d) - Other Pathological State* - This would represent another abnormal curve pattern - Could include conditions like ARDS, pneumothorax, or other restrictive/obstructive patterns - The specific interpretation depends on the curve shown in the image

Q: What is indicated by the 'water bottle appearance' of the heart size?

Pericardial effusion. ***Pericardial effusion*** - The **'water bottle appearance'** (globular cardiac silhouette) on chest X-ray is **pathognomonic** for a large **pericardial effusion** - Fluid accumulates in the pericardial space surrounding the heart, causing **symmetrical enlargement** of the cardiac shadow in all directions - The cardiac silhouette appears **smooth, globular, and enlarged**, resembling a water bottle lying on its side - Other features include **loss of normal cardiac contours** and a **wide cardiac base** *Dilated cardiomyopathy* - Causes cardiomegaly but maintains **chamber-specific enlargement patterns** rather than globular symmetry - Cardiac contours remain visible with **prominent ventricular borders** - Does not produce the characteristic smooth, flask-like appearance *Congestive heart failure* - Shows **pulmonary vascular congestion**, pleural effusions, and Kerley B lines in addition to cardiomegaly - Cardiac enlargement is **chamber-dependent** based on underlying etiology - Lacks the smooth, globular silhouette of pericardial effusion *Left ventricular hypertrophy* - Causes **focal left-sided cardiac enlargement** with apical displacement - Maintains **normal cardiac contours** with visible chamber borders - Does not produce generalized globular enlargement

Q: What does this CT chest image show?

Segmental collapse. ***Segmental collapse*** - The CT image shows loss of lung volume in a specific segment, indicated by the **crowding of bronchi and vessels in the affected area**, which is suggestive of atelectasis or collapse. - The black arrow points to the collapsed segment, which appears as a **densified, airless region within the lung parenchyma**, consistent with segmental collapse. *Consolidation* - **Consolidation** typically presents as an area of increased opacification due to alveolar filling with exudate or fluid, but without significant loss of lung volume. - Unlike collapse, consolidation generally **retains the lung architecture** and does not show crowding of vessels and bronchi. *Pneumothorax* - A **pneumothorax** is characterized by the presence of air in the pleural space, which would appear as a dark, air-filled space between the lung and the chest wall. - This typically leads to a **collapsed lung that is displaced medially** and no longer touches the chest wall, which is not seen here. *Pleural effusion* - **Pleural effusion** is the accumulation of fluid in the pleural space, presenting as a homogenous, gravity-dependent opacity that obscures lung parenchyma. - It would typically cause **blunting of the costophrenic angles** and a meniscus sign, which are not the primary findings indicated by the arrow.

Q: The given contrast enhanced CT scan chest shows presence of:

Cavity. ***Cavity*** - The CT scan image clearly shows a **well-defined, air-filled lucency within a consolidation** in the left lung, which is characteristic of a cavity. - The presence of an enhancing rim around the lucency suggests an **active inflammatory or neoplastic process** forming the cavity. *Pneumonia* - While pneumonia can cause consolidation, the image shows a distinct **focal air-filled space** within the area of consolidation, which is not typical for uncomplicated pneumonia. - Pneumonia would usually appear as a **homogenous or heterogeneous opacification** of the lung parenchyma, without such a clear cavity. *Lung contusion* - Lung contusion is typically associated with **trauma** and appears as **patchy, non-segmental ground-glass opacities or consolidation**. - It does not usually form a well-defined cavity with an enhancing wall, as seen in the image. *Segmental collapse* - Segmental collapse (atelectasis) would present as a **volume loss in a lung segment**, often with displacement of fissures or mediastinal structures, and increased attenuation of the collapsed lung. - The image shows a **focal lesion with internal lucency**, not a collapsed segment of lung, and there is no clear evidence of volume loss.

Q: A 30-year-old nephrotic syndrome patient travelled via a non-stop flight from San Francisco to New Delhi. On arrival at the destination, the patient started having difficulty in breathing and was rushed to the hospital. His $\mathrm{SpO}_{2}$ is $85\%$ and ECG shows sinus tachycardia with T wave inversion in lead III. CT chest was performed. What is the diagnosis?

Pulmonary embolism. ***Pulmonary embolism*** - The patient has several risk factors for pulmonary embolism (PE), including **nephrotic syndrome** (which causes hypercoagulability), and **prolonged immobility during a long-haul flight**. - The symptoms of **sudden dyspnea**, **hypoxia (SpO2 85%)**, and **sinus tachycardia with T wave inversion in lead III** (S1Q3T3 pattern, though incomplete, suggests right heart strain) are highly consistent with PE. The CT chest would likely confirm the presence of a **pulmonary thrombus**. *Anxiety* - While anxiety can cause dyspnea and tachycardia, it typically does not lead to significant **hypoxia (SpO2 85%)** or EKG changes indicating **right heart strain** like T-wave inversion in lead III. - There are clear predisposing factors and objective signs that point beyond a psychological cause. *Atypical pneumonia* - Atypical pneumonia typically presents with a more **gradual onset** of respiratory symptoms, often accompanied by cough and fever, which are not mentioned here. - While it can cause hypoxemia, the acute onset after travel and the specific ECG findings are less characteristic of pneumonia. *Myocardial infarction* - Myocardial infarction usually presents with **chest pain** and specific ECG changes such as **ST segment elevation** or depression, or Q waves, especially in leads other than lead III. - The T wave inversion in lead III, in the context of acute dyspnea and hypoxemia, is more suggestive of **right heart strain due to PE** than a primary myocardial event.

Q: A cement slab fell on the chest of a 20-year-old construction worker. His condition deteriorated over the next 24 hours after admission. A repeat CT chest was performed. What does it show?

ARDS. ***ARDS*** - The CT image shows diffuse **bilateral ground-glass opacities** and consolidation, consistent with **acute severe inflammation** and fluid accumulation in the lungs. - The history of severe blunt chest trauma (a cement slab falling on the chest) with subsequent clinical deterioration over 24 hours is a classic presentation leading to ARDS. *Bronchiolitis obliterans organising pneumonia* - This condition typically presents with **patchy, migratory consolidations** or ground-glass opacities, often peribronchovascular, which is not the primary pattern seen here. - While it can be secondary to lung injury, the rapid onset and diffuse nature following severe trauma are more characteristic of ARDS. *Hemothorax* - A hemothorax would appear as a **fluid collection** (high attenuation due to blood density) in the pleural space, typically layering dependently, not as widespread parenchymal opacification. - While possible following trauma, the image shows lung parenchymal changes rather than isolated pleural fluid. *Cardiac tamponade* - Cardiac tamponade involves the **accumulation of fluid in the pericardial sac**, leading to external compression of the heart and impaired filling. - This would manifest as an enlarged cardiac silhouette with effacement of cardiac chambers and possibly distended vena cava on CT, but not the diffuse pulmonary infiltrates seen here.

Q: A cement slab fell on the chest of a 20-year-old construction worker. The arrow in the given CT chest points to:

Lung contusion. ***Lung contusion*** - The image shows an area of **ground-glass opacity** and **consolidation** within the lung parenchyma, consistent with **hemorrhage and edema** caused by blunt force trauma. - This finding, combined with the history of the cement slab falling on the chest, is highly suggestive of a **lung contusion**. *ARDS* - **ARDS** (Acute Respiratory Distress Syndrome) is a clinical syndrome characterized by widespread **inflammatory lung injury**, typically presenting as bilateral infiltrates on imaging. - While it can manifest with similar CT findings, ARDS is a **diagnosis of exclusion** and requires specific clinical criteria (e.g., severe hypoxemia, exclusion of cardiac failure) not provided in the question. *Diaphragmatic rupture* - A **diaphragmatic rupture** involves a tear in the diaphragm, which would appear on CT as a discontinuity of the diaphragm or **herniation of abdominal contents** into the thoracic cavity. - The image does not show any signs of diaphragmatic discontinuity or organ herniation. *Pneumothorax* - A **pneumothorax** is the presence of air in the pleural space, which would be visible as a collection of **dark air outside the lung parenchyma**, often with a visible pleural line and collapse of the lung. - The CT scan shows parenchymal changes rather than a collection of air in the pleural space.

Q: The arrow in the given CT chest points to:

Pneumomediastinum. ***Pneumomediastinum*** - The arrow points to **gas (dark area)** within the mediastinum, highlighting the **mediastinal structures** like the aorta (seen as a bright, circular structure). - This presence of gas in the mediastinum, clearly delineated from the surrounding tissues, is characteristic of **pneumomediastinum**. *Pericardial effusion* - A pericardial effusion would appear as a **fluid collection** (gray scale) surrounding the heart, within the **pericardial sac**. - No such fluid collection is indicated by the arrow; instead, the arrow points to a distinct **air pocket**. *Diaphragmatic rupture* - Diaphragmatic rupture typically involves the **displacement of abdominal organs** into the thoracic cavity and/or a **discontinuity of the diaphragm**. - The image focuses on the mediastinum and upper chest, with no clear signs of a ruptured diaphragm or organ herniation. *Diaphragmatic eventration* - Diaphragmatic eventration is an abnormal **elevation of the hemidiaphragm** due to thinning or weakness of the muscle. - This condition is a **structural abnormality of the diaphragm**, showing an abnormally high diaphragm contour, which is not what the arrow indicates.

Question 1

A patient presented with sudden onset difficulty in breathing with RR 28/min, normal blood pressure. X-ray was taken which is given below. What is the diagnosis?

Accepted Answer

Hydro-pneumothorax

Answer

Pneumothorax

Answer

Pleural effusion

Answer

Consolidation

Question 2

Curve A signifies which of the following?

Accepted Answer

(a)

Answer

(b)

Answer

(c)

Answer

(d)

Question 3

What is indicated by the 'water bottle appearance' of the heart size?

Accepted Answer

Pericardial effusion

Answer

Dilated cardiomyopathy

Answer

Congestive heart failure

Answer

Left ventricular hypertrophy

Question 4

What does the CXR of a patient with cystic fibrosis show?

Accepted Answer

Hyperinflation with bronchiectasis predominantly in upper lobes

Answer

Bilateral pleural effusions with cardiomegaly

Answer

Bat wing pattern with Kerley B lines

Answer

Honeycombing in lower lobes with reticular opacities

Question 5

What does this CT chest image show?

Accepted Answer

Segmental collapse

Answer

Consolidation

Answer

Pneumothorax

Answer

Pleural effusion

Question 6

The given contrast enhanced CT scan chest shows presence of:

Accepted Answer

Cavity

Answer

Pneumonia

Answer

Lung contusion

Answer

Segmental collapse

Question 7

A 30-year-old nephrotic syndrome patient travelled via a non-stop flight from San Francisco to New Delhi. On arrival at the destination, the patient started having difficulty in breathing and was rushed to the hospital. His $\mathrm{SpO}_{2}$ is $85\%$ and ECG shows sinus tachycardia with T wave inversion in lead III. CT chest was performed. What is the diagnosis?

Accepted Answer

Pulmonary embolism

Answer

Anxiety

Answer

Atypical pneumonia

Answer

Myocardial infarction

Question 8

A cement slab fell on the chest of a 20-year-old construction worker. His condition deteriorated over the next 24 hours after admission. A repeat CT chest was performed. What does it show?

Accepted Answer

ARDS

Answer

Bronchiolitis obliterans organising pneumonia

Answer

Hemothorax

Answer

Cardiac tamponade

Question 9

A cement slab fell on the chest of a 20-year-old construction worker. The arrow in the given CT chest points to:

Accepted Answer

Lung contusion

Answer

ARDS

Answer

Diaphragmatic rupture

Answer

Pneumothorax

Question 10

The arrow in the given CT chest points to:

Accepted Answer

Pneumomediastinum

Answer

Pericardial effusion

Answer

Diaphragmatic rupture

Answer

Diaphragmatic eventration

Chest Radiology — MCQs

Chest Radiology — MCQs

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