Chest Radiology Practice Questions

Q: What is the most probable diagnosis based on the image provided?

RUL collapse. ***RUL collapse*** - RUL collapse (atelectasis) is identified radiographically by signs of **volume loss**, including superior displacement of the right hilum and cephalic bowing/displacement of the **minor fissure**. - The collapsed lobe causes increased opacification in the upper zone, often associated with the **"S" sign of Golden** if an obstructing hilar mass is present. *RUL consolidation* - Consolidation is characterized by filling of the airspaces with fluid/exudate, causing increased density but typically **without volume loss** (unlike collapse). - A key differentiating feature is the presence of a **patent air bronchogram**, meaning air-filled bronchi are visible against the opaque lung parenchyma. *Bronchogenic carcinoma* - While **bronchogenic carcinoma** is a very common cause of RUL collapse (due to endobronchial obstruction), the primary diagnosis based on the visible lung changes (**volume loss and opacification**) is the collapse itself. - The term carcinoma refers to the underlying **etiology**, not the specific radiological pattern of atelectasis shown in the image. *Lung abscess* - A lung abscess is defined by a localized area of necrosis and pus formation, typically appearing as a **thick-walled cavity**. - The defining characteristic feature that differentiates it from collapse is the presence of an **air-fluid level** within the cavity.

Q: A 4-year-old child with high grade fever with chills and rigors for past 4 days and fast breathing is brought to the hospital. On examination subcostal recession and nasal flaring is noted. Since patient is already on antibiotics for past 3 days from another hospital a Chest X-ray and CT Chest was ordered. The diagnosis is:

Massive right sided parapneumonic effusion. ***Massive right sided parapneumonic effusion*** - The chest x-ray shows complete opacification of the right hemithorax with a **mediastinal shift to the left**, indicating a large volume of fluid in the right pleural space. - The CT scan confirms a large, homogeneous fluid collection on the right side, compressing the lung and mediastinum, consistent with a **massive pleural effusion**, likely parapneumonic given the clinical context of fever and respiratory distress despite antibiotics. *Massive pan consolidation* - While consolidation would appear opaque on X-ray, **massive pan consolidation** of an entire lung would typically not cause such a significant **mediastinal shift** as fluid does. - The CT images show a distinct **fluid-density collection** rather than diffuse parenchymal opacification characteristic of consolidation. *Right sided hydro-pneumothorax* - A hydro-pneumothorax would present with a **fluid level** on the chest X-ray and CT scan, indicating both air and fluid in the pleural space. - The images show a **homogeneous fluid collection** without any discernible air component or fluid level, ruling out pneumothorax. *Right sided segmental collapse* - Segmental collapse would typically involve only a portion of the lung and would manifest as a **volume loss** in a specific segment, often with features like crowding of vessels and bronchi. - The findings depict an entire hemithorax filled with fluid causing **volume expansion** on the affected side rather than collapse.

Q: The chest X-ray of a cystic fibrosis patient shows presence of:

Bronchiectasis. ***Bronchiectasis*** - The X-ray shows diffuse, bilateral **peribronchial thickening** and **cystic lucencies**, particularly in the lower lobes, which are classic signs of bronchiectasis in a patient with cystic fibrosis. - **Bronchiectasis** is a common and progressive complication of cystic fibrosis due to recurrent infections and inflammation leading to permanent dilation and damage of the bronchi. *Left lower lobe pneumonia* - While pneumonia can occur in cystic fibrosis, the image demonstrates chronic changes rather than an acute consolidation typically seen with **left lower lobe pneumonia**. - **Pneumonia** would typically present with a more focal area of increased density, possibly with air bronchograms, which are not the predominant features here. *Bronchopneumonia* - **Bronchopneumonia** would show patchy areas of consolidation scattered throughout the lungs, often involving multiple lobes. - While there are opacities, the prominent **cystic changes** and **tram track lines** are more indicative of bronchiectasis than acute bronchopneumonia. *Right middle lobe collapse* - **Right middle lobe collapse** would manifest as a triangular opacity in the right mid-lung field, often associated with a shift of the right heart border and horizontal fissure. - This specific pattern of collapse is not observed; instead, there are generalized changes consistent with diffuse airway disease.

Q: An axial HRCT of the chest is shown. The image demonstrates small peripheral branching opacities due to mucoid impaction of contiguous branching bronchioles. What is the most likely diagnosis?

Endobronchial tuberculosis. ***Endobronchial tuberculosis*** - The HRCT shows **bronchiolar dilatation, wall thickening, and mucoid impaction** of contiguous branching bronchioles — the hallmarks of **endobronchial TB** - This produces the classic **"tree-in-bud" appearance**: small, branching peripheral opacities on CT resembling a budding tree - Endobronchial TB results from direct spread of mycobacteria to the bronchial mucosa, causing caseous necrosis, ulceration, and luminal narrowing *Allergic bronchopulmonary aspergillosis (ABPA)* - ABPA can also cause mucoid impaction but typically involves **central (proximal) bronchi** with **high-attenuation mucus plugs**; associated with asthma and eosinophilia - Does not classically produce the peripheral tree-in-bud pattern *Pulmonary alveolar proteinosis* - PAP characteristically shows the **"crazy paving" pattern** on CT — geographic ground-glass opacities with superimposed interlobular septal thickening - Tree-in-bud is not a feature of PAP *Sarcoidosis* - Sarcoidosis typically produces **perilymphatic nodules**, bilateral hilar lymphadenopathy, and may show the "galaxy sign" or beaded fissure sign - Tree-in-bud pattern is not characteristic of sarcoidosis

Q: The CT chest image shows large bullae in bilateral lung fields. This is diagnostic of which condition?

Emphysema. ***Emphysema*** - **Bullae** are characteristic findings in emphysema, representing abnormally enlarged airspaces within the lung parenchyma. - On CT scans, these appear as demarcated **lucencies (dark areas)**, often with thin walls, indicating destruction of alveolar walls and loss of elastic recoil. *Pneumonia* - Pneumonia typically presents with **consolidation** or **ground-glass opacities** on CT, indicating inflammation and fluid in the alveoli. - It does not typically cause the formation of large bullae; instead, it shows areas of increased density. *Bronchiectasis* - Bronchiectasis is characterized by irreversible **dilation of the bronchi**, often seen as "tram tracks" or "signet ring" signs on CT. - While it can involve air trapping, it does not primarily manifest as large bullae, but rather as thickened and dilated airways. *Interstitial fibrosis* - Interstitial fibrosis involves **thickening and scarring of the lung interstitium**, leading to a restrictive lung disease pattern. - CT findings would typically include **reticular opacities**, honeycombing, and traction bronchiectasis, not bullae.

Q: A chest X-ray shows bilateral reticular nodular shadows in both lung fields. The diaphragm is not flattened and the cardiothoracic ratio appears normal. What is the most likely pattern seen?

Reticular shadows. ***Reticular shadows*** - The CXR shows **bilateral reticular nodular shadows** without hyperinflation or cardiac enlargement - This pattern represents **thickened interstitial structures** forming a net-like (reticular) appearance - Characteristic of **interstitial lung diseases** such as idiopathic pulmonary fibrosis, interstitial pneumonitis, or collagen vascular disease - Normal cardiothoracic ratio and diaphragm position confirm this is an **interstitial pattern** *Incorrect: Emphysema* - Emphysema presents with **hyperinflation** and **flattening of the diaphragm** - Would show increased lucency, not reticular shadows - The normal diaphragm position rules out significant emphysema *Incorrect: Pulmonary edema* - Pulmonary edema typically shows **bat wing or perihilar distribution** - Associated with **increased cardiothoracic ratio** and **Kerley B lines** - The normal cardiac borders argue against cardiogenic pulmonary edema *Incorrect: Pericardial effusion* - Pericardial effusion presents with **enlarged cardiac silhouette** (water bottle heart) - **Increased cardiothoracic ratio** would be prominent - Does not produce reticular nodular lung field shadows - Normal cardiac borders on this CXR exclude significant pericardial effusion

Q: The image shows a standing upright chest X-ray with pleural reflection and a straight horizontal air-fluid level with absence of meniscus sign. What is the most likely diagnosis?

Hydropneumothorax. ***Correct: Hydropneumothorax*** - The image exhibits a **straight horizontal air-fluid level** in the pleural space, visible on an upright chest X-ray, which is characteristic of hydropneumothorax (simultaneous presence of both air and fluid in the pleural cavity). - The **absence of the meniscus sign (Ellis curve)** is the key distinguishing feature - this curved meniscus would be seen in a simple pleural effusion. - The **straight level** indicates air above fluid, confirming hydropneumothorax. *Incorrect: Pleural effusion* - Simple pleural effusion shows a **meniscus sign (Ellis curve)** - a curved upper border where fluid meets the chest wall. - No air-fluid level would be present, just homogeneous opacity with preserved meniscus. *Incorrect: Pneumothorax* - Pneumothorax shows **air only** in the pleural space with visible visceral pleural line. - No fluid level would be present - just absence of lung markings peripherally. *Incorrect: Empyema* - While empyema can occasionally show air-fluid level (if gas-forming organisms or bronchopleural fistula), it typically presents as a **loculated collection** with irregular borders and pleural thickening. - The classic straight air-fluid level is more characteristic of hydropneumothorax.

Question 1

Which of the following is the earliest radiological sign of acute respiratory distress syndrome (ARDS) on chest X-ray?

Accepted Answer

Bilateral diffuse alveolar infiltrates (ground-glass opacities)

Answer

Cardiomegaly

Answer

Pleural effusion

Answer

Kerley B lines

Question 2

A 65-year-old male smoker presents with hemoptysis and weight loss. Chest X-ray shows a central hilar mass with mediastinal widening. Which imaging modality is most appropriate for staging the extent of disease?

Accepted Answer

PET-CT scan

Answer

MRI chest

Answer

Contrast-enhanced CT chest with abdomen and pelvis

Answer

Bronchoscopy with biopsy

Question 3

What is the most probable diagnosis based on the image provided?

Accepted Answer

RUL collapse

Answer

Bronchogenic carcinoma

Answer

Lung abscess

Answer

RUL consolidation

Question 4

The CT chest shows presence of:

Accepted Answer

Meniscus sign

Answer

Crescent sign

Answer

Tree in bud sign

Answer

Loculated empyema

Question 5

A 4-year-old child with high grade fever with chills and rigors for past 4 days and fast breathing is brought to the hospital. On examination subcostal recession and nasal flaring is noted. Since patient is already on antibiotics for past 3 days from another hospital a Chest X-ray and CT Chest was ordered. The diagnosis is:

Accepted Answer

Massive right sided parapneumonic effusion

Answer

Massive pan consolidation

Answer

Right sided hydro-pneumothorax

Answer

Right sided segmental collapse

Question 6

The chest X-ray of a cystic fibrosis patient shows presence of:

Accepted Answer

Bronchiectasis

Answer

Left lower lobe pneumonia

Answer

Bronchopneumonia

Answer

Right middle lobe collapse

Question 7

An axial HRCT of the chest is shown. The image demonstrates small peripheral branching opacities due to mucoid impaction of contiguous branching bronchioles. What is the most likely diagnosis?

Accepted Answer

Endobronchial tuberculosis

Answer

Allergic bronchopulmonary aspergillosis

Answer

Pulmonary alveolar proteinosis

Answer

Sarcoidosis

Question 8

The CT chest image shows large bullae in bilateral lung fields. This is diagnostic of which condition?

Accepted Answer

Emphysema

Answer

Pneumonia

Answer

Bronchiectasis

Answer

Interstitial fibrosis

Question 9

A chest X-ray shows bilateral reticular nodular shadows in both lung fields. The diaphragm is not flattened and the cardiothoracic ratio appears normal. What is the most likely pattern seen?

Accepted Answer

Reticular shadows

Answer

Emphysema

Answer

Pulmonary edema

Answer

Pericardial effusion

Question 10

The image shows a standing upright chest X-ray with pleural reflection and a straight horizontal air-fluid level with absence of meniscus sign. What is the most likely diagnosis?

Accepted Answer

Hydropneumothorax

Answer

Pleural effusion

Answer

Pneumothorax

Answer

Empyema

Chest Radiology — MCQs

Chest Radiology — MCQs

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