Chest Radiology — MCQs

Chest Radiology Indian Medical PG Practice Questions and MCQs

Question 491: Inverted mustache sign is seen in

A. Pulmonary Venous hypertension (Correct Answer)
B. HOCM
C. Amyloidosis
D. Small VSD

Explanation: ***Pulmonary Venous hypertension*** - The "inverted mustache sign" refers to the **engorgement of pulmonary veins** visible on a chest X-ray, typically seen in severe pulmonary venous hypertension. - This sign indicates increased pressure within the pulmonary venous system, often due to **left heart failure** or **mitral valve disease**. *HOCM* - **Hypertrophic obstructive cardiomyopathy** (HOCM) is characterized by thickening of the ventricular septum, leading to outflow tract obstruction. - While it can lead to elevated left atrial pressures and pulmonary venous congestion, the "inverted mustache sign" is **not a specific or classic radiographic finding** for HOCM. *Amyloidosis* - **Cardiac amyloidosis** leads to restrictive cardiomyopathy due to **amyloid protein deposition** in the myocardial tissue. - This can cause **diastolic dysfunction** and elevated pulmonary venous pressures, but the specific "inverted mustache sign" is not directly associated with amyloidosis as a primary or pathognomonic finding. *Small VSD* - A **small ventricular septal defect** (VSD) typically results in a **left-to-right shunt**, which may cause increased pulmonary blood flow, but usually not significant enough to cause severe pulmonary venous hypertension or the "inverted mustache sign." - Significant pulmonary venous hypertension and engorgement are more characteristic of conditions affecting the **left side of the heart** (e.g., mitral stenosis, left ventricular failure).

Question 492: All are chest X-ray signs of pulmonary embolism except for which of the following?

A. Fleischner sign
B. Monod sign (Correct Answer)
C. Hampton's hump
D. Westermark's sign

Explanation: ***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.

Question 493: Hypertranslucency of the lung is seen unilaterally on all except –

A. Pneumonectomy
B. Resection of mammary gland (Correct Answer)
C. Pneumothorax
D. Pulmonary artery obstruction

Explanation: ***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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Mediastinal Pathology

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Pulmonary Vascular Diseases

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Post-Surgical Chest Imaging

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