Chest Radiology Practice Questions

Q: A 53-year-old female nonsmoker is being evaluated with symptoms of progressive shortness of breath. She has a past history of trauma to the right side of the chest. There is no history of asthma, sputum production, or recent chest pain. Chest X-ray is shown. What is the likely diagnosis?

Organized hemothorax. ***Organized hemothorax*** - **Post-traumatic history** of right chest trauma combined with **progressive dyspnea** and **pleural thickening** on chest X-ray strongly suggests organized hemothorax (fibrothorax). - Blood collection in the pleural space after trauma can organize into **fibrous tissue**, causing **pleural restriction** and progressive respiratory symptoms. *Calcified cyst* - Would typically appear as a **well-defined, round lesion** with **rim calcification** on chest X-ray, not diffuse pleural thickening. - **No association** with chest trauma history and would not cause progressive dyspnea through pleural restriction. *Blastomycosis* - A **fungal infection** that typically presents with **pulmonary nodules** or **mass-like lesions**, not pleural thickening. - Would be associated with **systemic symptoms** like fever, weight loss, and **productive cough**, which are absent in this case. *Asbestosis* - Requires **occupational exposure** to asbestos fibers, typically in construction or shipyard workers. - Presents with **bilateral lower lobe fibrosis** and **pleural plaques**, not unilateral right-sided pleural thickening following trauma.

Q: HRCT is the investigation of choice for diagnosing all of the following conditions, EXCEPT?

Pulmonary artery aneurysm. **Explanation:** High-Resolution Computed Tomography (HRCT) is the gold standard for evaluating the **lung parenchyma** and small airways. It uses thin slices (1–2 mm) and high-spatial-frequency reconstruction algorithms to provide detailed images of the pulmonary interstitium. **Why Pulmonary Artery Aneurysm is the Correct Answer:** A pulmonary artery aneurysm is a **vascular pathology**. HRCT is performed without intravenous contrast and is optimized for air-filled structures and lung tissue, making it inadequate for visualizing the vascular lumen. The investigation of choice for diagnosing vascular abnormalities like aneurysms or pulmonary embolism is **CT Pulmonary Angiography (CTPA)**, which utilizes a rapid bolus of IV contrast. **Analysis of Other Options:** * **Sarcoidosis:** HRCT is excellent for identifying characteristic perilymphatic nodules, hilar lymphadenopathy, and parenchymal changes. * **Miliary Tuberculosis:** HRCT is highly sensitive in detecting the classic 1–3 mm "miliary" (randomly distributed) nodules that may be missed on a standard chest X-ray. * **Interstitial Fibrosis:** HRCT is the definitive tool for diagnosing Interstitial Lung Diseases (ILD). It identifies specific patterns like honeycombing, traction bronchiectasis, and reticular opacities (e.g., UIP pattern). **NEET-PG High-Yield Pearls:** * **HRCT slice thickness:** 1 to 2 mm (compared to 5–10 mm in conventional CT). * **Windowing:** Uses a "Lung Window" (Width: 1500 HU; Level: -600 to -700 HU). * **Signet Ring Sign:** Seen on HRCT in Bronchiectasis (dilated bronchus larger than its accompanying artery). * **Halo Sign:** Characteristic of Invasive Aspergillosis. * **Crazy Paving Pattern:** Classically seen in Alveolar Proteinosis.

Q: Kerley B lines are seen in which of the following conditions?

All of the above. **Explanation:** Kerley B lines are a classic radiological sign seen on a chest X-ray. They represent **interlobular septal thickening** caused by the accumulation of fluid, cells, or connective tissue in the peripheral pulmonary interstitium. 1. **Why "All of the above" is correct:** * **Pulmonary Edema (Option A):** This is the most common cause. Increased pulmonary venous pressure (as seen in Left Ventricular Failure or Mitral Stenosis) leads to transudation of fluid into the interlobular septa. * **Congenital Heart Disease (Option B):** Conditions causing chronic pulmonary venous hypertension or increased pulmonary blood flow (e.g., Total Anomalous Pulmonary Venous Return or large VSDs) can lead to septal thickening. * **Sarcoidosis (Option C):** In granulomatous diseases, the septa thicken due to cellular infiltration or fibrosis rather than fluid. 2. **Understanding Kerley Lines:** * **Kerley B lines:** Short (1–2 cm), thin, horizontal lines perpendicular to the pleura, most commonly seen at the **costophrenic angles** (bases). * **Kerley A lines:** Longer (2–6 cm) lines radiating from the hila toward the central parenchyma. * **Kerley C lines:** Short, fine lines forming a reticular (mesh-like) pattern throughout the lungs. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Kerley B lines (CHIPS):** **C**arcinomatosis lymphangitica, **H**eart failure (Pulmonary edema), **I**diopathic pulmonary fibrosis, **P**neumoconiosis, **S**arcoidosis. * **Carcinomatosis Lymphangitica:** Often presents with unilateral Kerley B lines (highly suggestive of malignancy). * **Mitral Stenosis:** Classically associated with Kerley B lines due to chronic elevation of left atrial pressure.

Q: Which of the following statements is NOT true regarding Pectus excavatum?

Heart shifted towards the right side. **Explanation:** **Pectus excavatum** (funnel chest) is the most common congenital chest wall deformity, characterized by a concave depression of the sternum. This structural abnormality reduces the anteroposterior (AP) diameter of the chest, leading to specific radiological findings. 1. **Why Option D is the Correct Answer (The False Statement):** In Pectus excavatum, the depressed sternum physically compresses the heart against the spine. Because the heart cannot move posteriorly, it is typically **displaced to the left** and rotated. Displacement to the right is not a feature of this condition; therefore, Option D is the false statement. 2. **Analysis of Other Options:** * **Option A:** As explained above, the heart is characteristically shifted to the **left**, which can sometimes mimic cardiomegaly on a PA view. * **Option B:** The depressed sternum and overlying soft tissues can cause an area of increased opacity over the right heart border. This often obscures the right heart border, mimicking **Right Middle Lobe (RML) consolidation** (the "pseudo-silhouette sign"). * **Option C:** Due to the sternal depression, the **anterior ribs** take on a more **vertical/steep orientation**, often described as a **"7-shaped"** or "verticalized" appearance on a frontal chest X-ray. **Clinical Pearls for NEET-PG:** * **Haller Index:** Used on CT to quantify severity (Lateral diameter / AP diameter). A value **>3.25** is usually considered severe and may require surgical correction (e.g., Nuss procedure). * **Lateral X-ray:** This is the definitive view to confirm the diagnosis, showing the posterior displacement of the lower sternum. * **Associations:** Often associated with Marfan syndrome, Ehlers-Danlos syndrome, and scoliosis.

Q: Superior rib notching is not associated with which of the enlisted conditions?

Blalock-Taussig shunt. **Explanation:** Rib notching is a high-yield topic in chest radiology. To answer this question, one must distinguish between **inferior** and **superior** rib notching. **Why Blalock-Taussig (BT) Shunt is the correct answer:** A BT shunt (specifically the classic version) involves anastomosing the subclavian artery to the pulmonary artery. This reduces blood flow to the intercostal arteries on the ipsilateral side. Consequently, it causes **inferior rib notching** (due to collateral retrograde flow through dilated intercostal arteries), not superior. Inferior notching is typically associated with vascular pressure/dilatation (e.g., Coarctation of the aorta), whereas superior notching is associated with disturbances in osteoblastic/osteoclastic activity or connective tissue pressure. **Analysis of Incorrect Options (Causes of Superior Rib Notching):** * **Hyperparathyroidism (A):** This is the most common cause of superior rib notching due to subperiosteal bone resorption along the upper margin of the ribs. * **Marfan Syndrome (B):** Connective tissue disorders lead to a deficiency in the supportive matrix of the bone, making the superior aspect of the ribs susceptible to pressure erosion. * **Systemic Lupus Erythematosus (D):** Chronic inflammation and corticosteroid use in SLE can lead to localized bone resorption and superior rib thinning/notching. **NEET-PG High-Yield Pearls:** 1. **Inferior Rib Notching (Roesler’s Sign):** Most commonly seen in **Coarctation of the Aorta** (3rd to 8th ribs; spares 1st and 2nd). 2. **Superior Rib Notching:** Think "Mnemonic: **SHAM**" — **S**cleroderma/SLE, **H**yperparathyroidism, **A**lkaptonuria, **M**arfan syndrome/Melorheostosis. 3. **Unilateral Inferior Notching:** Seen in classic BT shunt or subclavian artery stenosis.

Q: Pulmonary plethora is seen in which of the following conditions?

Total anomalous pulmonary venous connection (TAPVC). **Explanation:** **Pulmonary Plethora** (increased pulmonary vascularity) occurs when there is a **Left-to-Right shunt**, leading to an increased volume of blood flowing through the pulmonary arteries. On a chest X-ray, this is characterized by prominent pulmonary markings extending to the outer third of the lung fields and enlargement of the main pulmonary artery. **Why TAPVC is correct:** Total Anomalous Pulmonary Venous Connection (TAPVC) is a cyanotic congenital heart disease characterized by a **Left-to-Right shunt**. Since all pulmonary veins drain into the right atrium (instead of the left), the pulmonary circulation receives a massive excess of blood volume, leading to classic pulmonary plethora. In the supracardiac type, this produces the characteristic **"Snowman" or "Figure-of-8" appearance** on X-ray. **Why the other options are incorrect:** * **Tetralogy of Fallot (TOF):** Characterized by pulmonary stenosis, which restricts blood flow to the lungs, resulting in **pulmonary oligemia** (decreased vascularity) and a "boot-shaped" heart (Coeur en sabot). * **Ebstein Anomaly:** Involves tricuspid regurgitation and a "wall-to-wall" globular heart. The right-to-left shunt at the atrial level leads to **pulmonary oligemia**. * **Tricuspid Atresia:** Due to the lack of a tricuspid valve, blood flow to the right ventricle and pulmonary artery is severely diminished, resulting in **pulmonary oligemia**. **High-Yield Clinical Pearls for NEET-PG:** * **Plethora (L $\to$ R Shunt):** ASD, VSD, PDA, TAPVC, Transposition of Great Arteries (TGA), Truncus Arteriosus. * **Oligemia (Decreased Flow):** TOF, Ebstein anomaly, Tricuspid atresia, Pulmonary stenosis. * **TAPVC X-ray Sign:** "Snowman sign" (Supracardiac type). * **TGA X-ray Sign:** "Egg-on-side" appearance.

Q: Westermark's sign is seen in which of the following conditions?

Pulmonary embolism. **Explanation:** **Westermark’s sign** is a classic, though infrequent, radiographic finding in **Pulmonary Embolism (PE)**. It refers to a focal area of **oligemia** (reduced vascular markings) distal to an occluded pulmonary artery. This occurs because the thrombus obstructs blood flow, leading to a "lucent" or darker appearance of the lung parenchyma in that specific segment. While highly specific for PE, its sensitivity is low. **Analysis of Options:** * **Pulmonary Sequestration:** Characterized by non-functioning lung tissue with an anomalous systemic arterial supply. On imaging, it typically appears as a solid mass or cystic lesion, often in the left lower lobe. * **Pulmonary Alveolar Proteinosis (PAP):** Classically presents with a **"Crazy Paving" pattern** (ground-glass opacities with superimposed interlobular septal thickening) on HRCT, not focal oligemia. * **Allergic Bronchopulmonary Aspergillosis (ABPA):** Key radiographic features include **"Finger-in-glove" opacities** due to mucoid impaction and central bronchiectasis. **High-Yield Clinical Pearls for NEET-PG:** * **Hampton’s Hump:** A wedge-shaped, pleural-based opacity representing pulmonary infarction (also seen in PE). * **Palla’s Sign:** Enlargement of the right descending pulmonary artery in PE. * **Fleischner Sign:** Prominent central pulmonary artery due to a large embolus. * **Gold Standard Investigation:** CT Pulmonary Angiography (CTPA) is the investigation of choice for PE. * **Knuckle Sign:** Abrupt tapering of a pulmonary artery secondary to an embolus.

Q: A chest X-ray shows an opacity in the lung with irregular calcification. What is this suggestive of?

Hamartoma. **Explanation:** **Hamartoma** is the most common benign tumor of the lung. The classic radiological hallmark of a pulmonary hamartoma is **"Popcorn Calcification"** (irregular, coarse, or speckled calcification). These lesions are typically small (<3 cm), peripheral, well-circumscribed, and slow-growing. The presence of fat density on a CT scan (Hounsfield units -40 to -120) combined with popcorn calcification is pathognomonic for hamartoma. **Analysis of Incorrect Options:** * **Lung Carcinoma:** While malignancies can show calcification (eccentric or stippled), it is rare. Malignant lesions usually present with "spiculated" margins, rapid doubling time, and a lack of organized calcification. * **Hydatid Cyst:** Typically presents as a well-defined, water-density fluid-filled cyst. Classic signs include the **"Water Lily sign"** (Camasalotte sign) or **"Crescent sign."** Calcification, if present, is usually curvilinear or peripheral (wall calcification), not irregular/popcorn-like. * **Adenoma:** Bronchial adenomas (like Carcinoid tumors) are usually central/endobronchial. While they can occasionally calcify, they typically present with signs of airway obstruction like distal collapse or obstructive pneumonitis. **NEET-PG High-Yield Pearls:** * **Popcorn Calcification:** Seen in Pulmonary Hamartoma and Fibroadenoma of the breast. * **Benign Calcification Patterns:** Diffuse, central, laminated (target), and popcorn. * **Malignant Calcification Patterns:** Eccentric, stippled, or fine/punctate. * **Fleischner Society Guidelines:** Used for the management of incidental pulmonary nodules. * **Feeding Vessel Sign:** Classically associated with Septic Emboli or Metastasis.

Q: Sequestration lung is best diagnosed by which imaging modality?

Angiography. **Explanation:** **Pulmonary sequestration** is a congenital anomaly characterized by a non-functioning mass of lung tissue that lacks normal communication with the tracheobronchial tree and, most importantly, receives its **systemic arterial blood supply** (usually from the abdominal or thoracic aorta) rather than the pulmonary arteries. 1. **Why Angiography is the Correct Answer:** The definitive diagnosis of pulmonary sequestration depends on the identification of this **aberrant systemic arterial supply**. Historically and classically, **Angiography** is considered the "gold standard" because it precisely maps the origin and course of the anomalous artery, which is crucial for surgical planning to prevent fatal intraoperative hemorrhage. 2. **Why Other Options are Incorrect:** * **CT Scan:** While Multidetector CT (MDCT) angiography is now the practical first-line investigation in modern clinical practice, traditional "CT scan" (without specific vascular focus) is less definitive than angiography for identifying the aberrant vessel. * **MRI:** MR Angiography is a non-invasive alternative but is generally not the primary diagnostic standard compared to conventional or CT angiography. * **Barium Swallow:** This is used to rule out associated gastrointestinal communications (bronchopulmonary foregut malformations) but cannot diagnose the vascular anomaly itself. **High-Yield Clinical Pearls for NEET-PG:** * **Intralobar Sequestration (75%):** Located within the normal visceral pleura; usually presents in adulthood with recurrent infections; venous drainage is typically via pulmonary veins. * **Extralobar Sequestration (25%):** Has its own pleural investment; usually presents in neonates with respiratory distress or associated anomalies (e.g., diaphragmatic hernia); venous drainage is via systemic veins (azygos/hemi-azygos). * **Most common location:** Posterior basal segment of the Left Lower Lobe.

Q: Nipple shadows in a chest X-ray characteristically have a sharp:

Lateral margin. **Explanation:** Nipple shadows are a common mimic of pulmonary nodules on a chest X-ray. The characteristic appearance of a nipple shadow is defined by the **Mach band effect** and the tangential orientation of the X-ray beam. **Why the Lateral Margin is correct:** The lateral margin of the nipple is typically surrounded by air, creating a sharp interface with the skin. Because the X-ray beam strikes this interface tangentially, it produces a **well-defined, sharp lateral border**. Conversely, the medial aspect of the nipple gradually blends into the soft tissue of the breast or chest wall, resulting in an ill-defined or "fuzzy" medial margin. This "sharp-lateral, blurred-medial" appearance is a classic radiological sign used to differentiate a nipple shadow from an intrapulmonary lesion. **Analysis of Incorrect Options:** * **Medial Margin:** As noted, the medial side lacks a sharp air-tissue interface, making it appear hazy. * **Superior/Inferior Margins:** While these may occasionally appear somewhat defined, they do not consistently exhibit the characteristic sharpness seen on the lateral edge due to the anatomical contour of the nipple. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Nipple shadows are typically located in the 4th or 5th intercostal spaces, usually lateral to the midclavicular line. * **Symmetry:** They are often bilateral and symmetric, which helps rule out pathology. * **Confirmatory Step:** If a nipple shadow is suspected to be a lung nodule, the next best step is a **repeat X-ray with nipple markers** (e.g., small metallic pellets taped over the nipples). * **Differential Diagnosis:** Always differentiate from "Coin lesions" (e.g., granulomas, hamartomas, or malignancy). A true pulmonary nodule usually has sharp borders all around (360 degrees).

Question 1

A 53-year-old female nonsmoker is being evaluated with symptoms of progressive shortness of breath. She has a past history of trauma to the right side of the chest. There is no history of asthma, sputum production, or recent chest pain. Chest X-ray is shown. What is the likely diagnosis?

Accepted Answer

Organized hemothorax

Answer

Calcified cyst

Answer

Blastomycosis

Answer

Asbestosis

Question 2

HRCT is the investigation of choice for diagnosing all of the following conditions, EXCEPT?

Accepted Answer

Pulmonary artery aneurysm

Answer

Sarcoidosis

Answer

Miliary tuberculosis

Answer

Interstitial fibrosis

Question 3

Kerley B lines are seen in which of the following conditions?

Accepted Answer

All of the above

Answer

Pulmonary edema

Answer

Congenital heart disease

Answer

Sarcoidosis

Question 4

Which of the following statements is NOT true regarding Pectus excavatum?

Accepted Answer

Heart shifted towards the right side

Answer

Heart shifted towards the left side

Answer

May present with features suggestive of right middle lobe consolidation

Answer

Anterior ribs are more vertically oriented, resulting in a '7-shaped' appearance

Question 5

Superior rib notching is not associated with which of the enlisted conditions?

Accepted Answer

Blalock-Taussig shunt

Answer

Hyperparathyroidism

Answer

Marfan syndrome

Answer

Systemic lupus erythematosus

Question 6

Pulmonary plethora is seen in which of the following conditions?

Accepted Answer

Total anomalous pulmonary venous connection (TAPVC)

Answer

Tetralogy of Fallot (TOF)

Answer

Ebstein anomaly

Answer

Tricuspid atresia

Question 7

Westermark's sign is seen in which of the following conditions?

Accepted Answer

Pulmonary embolism

Answer

Pulmonary sequestration

Answer

Pulmonary alveolar proteinosis

Answer

Allergic bronchopulmonary aspergillosis

Question 8

A chest X-ray shows an opacity in the lung with irregular calcification. What is this suggestive of?

Accepted Answer

Hamartoma

Answer

Lung carcinoma

Answer

Hydatid cyst

Answer

Adenoma

Question 9

Sequestration lung is best diagnosed by which imaging modality?

Accepted Answer

Angiography

Answer

CT scan

Answer

MRI

Answer

Barium swallow

Question 10

Nipple shadows in a chest X-ray characteristically have a sharp:

Accepted Answer

Lateral margin

Answer

Medial margin

Answer

Superior margin

Answer

Inferior margin

Chest Radiology — MCQs

Chest Radiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?