Chest Radiology Practice Questions

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 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.

Q: What does the following CT chest show?

Crazy pavement pattern. ***Crazy pavement pattern*** - The image shows a **crazy paving pattern**, characterized by widespread **ground-glass opacities** superimposed with **thickened interlobular and intralobular septa**. - This pattern is highly suggestive of conditions like **pulmonary alveolar proteinosis** or acute interstitial pneumonias, indicating diffuse alveolar damage. *Honeycomb pattern* - **Honeycombing** refers to cyst-like spaces with thick, fibrous walls and is diagnostic of **fibrotic lung disease**, typically seen in later stages. - The image lacks the characteristic discrete, thick-walled cysts associated with honeycombing. *Signet ring pattern* - The **signet ring sign** is seen in **bronchiectasis**, where a dilated bronchus (the "ring") is accompanied by a smaller pulmonary artery (the "gemstone"). - This pattern is not visible in the provided image, which shows diffuse lung changes rather than localized bronchial dilatation. *Mosaic pattern* - A **mosaic pattern** typically describes areas of varying attenuation, often reflecting **air trapping** or infiltrative lung disease leading to perfusion defects. - While there are areas of varying density, they are specifically associated with septal thickening, which makes "crazy paving" a more accurate descriptor.

Q: The following lung window in CT chest is taken in which phase of respiration?

End inspiratory phase. ***End inspiratory phase*** - In the **end inspiratory phase**, the lungs are maximally expanded and appear quite dark (lucent) on CT, indicating a high volume of air. - The image shows expanded lung fields with numerous scattered opacities, which are better visualized against the well-aerated lung parenchyma, consistent with maximal inspiration. *End expiratory phase* - In an **end expiratory phase** CT, the lungs would appear smaller and denser due to reduced air volume, and structures would be more crowded, which is not seen here. - Expiratory CTs are typically used to detect **air trapping**, where areas of the lung remain abnormally lucent despite exhalation. *Mid inspiratory* - While showing some degree of lung expansion, a **mid inspiratory phase** would not demonstrate the maximal lucency and full expansion evident in the provided image. - It would be an intermediate state between maximal inspiration and expiration, with less overall lung volume than what is depicted. *Cannot be determined* - The distinct **appearance of the lung fields**, characterized by their large volume and lucency, strongly indicates the phase of respiration. - The visualization of scattered opacities suggests that imaging was performed to best demonstrate these findings within maximally inflated lungs.

Q: The lung parenchyma on CT chest shown below is best described as:

Crazy pavement pattern. ***Crazy pavement pattern*** - The image distinctly shows a combination of **ground-glass opacities** and superimposed **interlobular septal thickening**, which together create the characteristic "crazy paving" appearance. - This pattern is most commonly associated with **pulmonary alveolar proteinosis**, but can also be seen in conditions like ARDS, PCP pneumonia, and lipoid pneumonia. *Honey comb pattern* - This pattern involves the presence of multiple, clustered, thick-walled **cysts** of varying sizes, typically subpleural, which are a sign of **end-stage lung fibrosis**. - While there are cystic changes in the image, the predominant finding includes ground-glass opacities and septal thickening rather than pure end-stage fibrotic changes. *Signet ring pattern* - A signet ring pattern is classically seen in **bronchiectasis**, where a dilated bronchus is paired with its accompanying smaller pulmonary artery, resembling a signet ring. - The image does not show clearly dilated bronchi adjacent to pulmonary arteries; instead, it displays diffuse parenchymal changes. *Mosaic pattern* - The mosaic pattern refers to areas of differing lung attenuation, often due to **air trapping** (causing dark areas) or areas of **perfusion abnormalities** (creating lighter areas), common in conditions like small airway disease or chronic thromboembolic disease. - While there is some heterogeneity, the specific combination of ground-glass and septal thickening is more accurately described as crazy paving.

Q: An 18-year-old boy is brought to the hospital with difficulty in breathing after a bar fight. What does the given CT chest show?

Pneumothorax. ***Pneumothorax*** - The CT image shows a clear **absence of lung parenchyma** extending to the chest wall, with a visible **visceral pleural line** separated from the parietal pleura. This indicates air in the pleural space, which is characteristic of a pneumothorax. - The patient presenting with **difficulty in breathing** after a bar fight (implying trauma) is consistent with a **traumatic pneumothorax**. *Consolidation* - **Consolidation** appears as a region of increased attenuation (whitening) on CT, usually with **air bronchograms**, indicating filling of alveolar spaces, which is not seen here. - While it can cause difficulty breathing, it results from infection or inflammation, not typically direct trauma creating an empty space like in the image. *Pulmonary contusion* - **Pulmonary contusion** would appear as areas of **ground-glass opacity** or **consolidation** within the lung parenchyma due to bleeding and edema, without a significant collapse of the lung. - The image distinctly shows a collapsed lung with a clear air-filled pleural space, not parenchymal injury. *Haemothorax* - A **hemothorax** would show a **fluid collection** (appearing white or grey) in the pleural space, often layering dependently, which is not the primary finding on this image where an air-filled space is prominent. - While a traumatic event could lead to both pneumothorax and hemothorax (**hemopneumothorax**), the most striking feature evident here is the air within the pleural cavity causing lung collapse.

Q: What does the following CT chest show?

Ground glass appearance. ***Ground glass appearance*** - The image displays hazy opacification of the lung parenchyma, where **bronchial and vascular margins remain visible**. This pattern is characteristic of ground-glass opacity, indicating partial filling of air spaces or interstitial thickening. - This finding is often associated with conditions like **pneumonitis**, early acute respiratory distress syndrome (ARDS), or some atypical infections, where there's fluid or cellular infiltrates in the alveoli without complete consolidation. *Honey comb pattern* - **Honeycomb lung** is characterized by the presence of multiple cystic airspaces with thick, fibrotic walls, typically occurring in subpleural and peripheral lung regions. - This pattern signifies **end-stage pulmonary fibrosis** and is distinct from the more widespread, hazy opacification seen in the provided image. *Signet ring pattern* - The **signet ring sign** is typically observed in **bronchiectasis**, where a dilated bronchus (the "ring") is accompanied by a smaller, adjacent pulmonary artery (the "gemstone"). - This pattern indicates irreversible widening of the airways and is not represented by the diffuse hazy lung changes in the image. *Crazy pavement pattern* - **Crazy paving** refers to a combination of widespread **ground-glass opacities superimposed on thickened interlobular septa and intralobular lines**. - While the image shows ground-glass change, the prominent and widespread septal thickening required to meet the criteria for crazy paving is not clearly evident throughout the affected areas.

Question 1

What does this CT chest image show?

Accepted Answer

Segmental collapse

Answer

Consolidation

Answer

Pneumothorax

Answer

Pleural effusion

Question 2

The given contrast enhanced CT scan chest shows presence of:

Accepted Answer

Cavity

Answer

Pneumonia

Answer

Lung contusion

Answer

Segmental collapse

Question 3

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 4

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 5

The arrow in the given CT chest points to:

Accepted Answer

Pneumomediastinum

Answer

Pericardial effusion

Answer

Diaphragmatic rupture

Answer

Diaphragmatic eventration

Question 6

What does the following CT chest show?

Accepted Answer

Crazy pavement pattern

Answer

Honeycomb pattern

Answer

Signet ring pattern

Answer

Mosaic pattern

Question 7

The following lung window in CT chest is taken in which phase of respiration?

Accepted Answer

End inspiratory phase

Answer

End expiratory phase

Answer

Mid inspiratory

Answer

Cannot be determined

Question 8

The lung parenchyma on CT chest shown below is best described as:

Accepted Answer

Crazy pavement pattern

Answer

Honey comb pattern

Answer

Signet ring pattern

Answer

Mosaic pattern

Question 9

An 18-year-old boy is brought to the hospital with difficulty in breathing after a bar fight. What does the given CT chest show?

Accepted Answer

Pneumothorax

Answer

Consolidation

Answer

Pulmonary contusion

Answer

Haemothorax

Question 10

What does the following CT chest show?

Accepted Answer

Ground glass appearance

Answer

Honey comb pattern

Answer

Signet ring pattern

Answer

Crazy pavement pattern

Chest Radiology — MCQs

Chest Radiology — MCQs

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