Chest Radiology Practice Questions

Q: Which of the following is NOT a chest radiographic feature of left atrial enlargement?

Boot-shaped heart. ***Boot-shaped heart*** - A **boot-shaped heart** (coeur en sabot) is characteristic of **Tetralogy of Fallot** due to right ventricular hypertrophy, NOT left atrial enlargement. - This configuration results from an upturned cardiac apex and concave main pulmonary artery segment. - This is the correct answer as it is **NOT** a radiographic feature of left atrial enlargement. *Elevated left main bronchus* - This **IS a feature** of left atrial enlargement, where the enlarged left atrium pushes superiorly on the left main bronchus. - The normal carinal angle is about 60 degrees; left atrial enlargement increases this angle. *Enlargement of left atrial appendage* - This **IS a feature** of left atrial enlargement, commonly seen in conditions like mitral stenosis. - The left atrial appendage creates a convex bulge along the left cardiac border below the pulmonary artery segment. - It is a common site for thrombus formation in atrial fibrillation with mitral valve disease. *Splaying of carina* - This **IS a feature** of left atrial enlargement, where the enlarged left atrium pushes the carina superiorly from below. - A carinal angle greater than **75-90 degrees** is generally considered indicative of left atrial enlargement. - Also called widening of the subcarinal angle.

Q: Chest x-ray of a child presenting with acute breathlessness. What is the most likely diagnosis?

Pneumothorax. ***Pneumothorax*** - A **pneumothorax** occurs when air leaks into the space between the lung and chest wall, leading to lung collapse or partial collapse. - The chest X-ray shows a **collapsed left lung** with a prominent **visceral pleural line**, indicating air in the pleural space, which is characteristic of pneumothorax. - This is the most common cause of **acute breathlessness** with this radiographic appearance in children. *Pneumatocele* - A **pneumatocele** is a thin-walled, air-filled cyst within the lung parenchyma, often forming after pneumonia or trauma. - While air-filled, pneumatoceles are **intraparenchymal** (within lung tissue) and appear as round lucencies, not causing a collapsed lung with a pleural line. *Pleural effusion* - **Pleural effusion** presents with fluid (not air) in the pleural space, causing **blunting of costophrenic angles** and a homogeneous white opacity. - The radiographic findings show air and lung collapse, not fluid accumulation. *Normal* - A **normal chest X-ray** would show fully expanded lungs bilaterally with appropriate vascular markings and no pleural abnormalities. - The presence of lung collapse and visceral pleural line clearly indicates pathology.

Q: HRCT features of interstitial pneumonia include all of the following EXCEPT:

Bronchiectatic features. ***Bronchiectatic features*** - **Bronchiectatic features** (e.g., dilatation of bronchi) are usually indicative of diseases that cause destruction and widening of the airways, such as **cystic fibrosis** or severe infections, rather than primary interstitial lung diseases. - While some interstitial lung diseases can have associated airway abnormalities, **bronchiectasis** is not a hallmark or typical primary feature of **interstitial pneumonia** itself. *Reticular opacities* - **Reticular opacities**, appearing as a network of fine lines, are a common and characteristic finding in many forms of **interstitial pneumonia**, particularly those with **fibrotic changes**. - They represent **interstitial thickening** due to fibrosis or inflammation. *Honeycombing* - **Honeycombing**, characterized by clustered **cystic airspaces** usually less than 1 cm in diameter, is a definitive sign of **end-stage pulmonary fibrosis**, a common outcome of chronic interstitial pneumonia. - It is considered an irreversible feature and indicates significant architectural distortion of the lung parenchyma. *Ground glass opacities* - **Ground glass opacities** (GGOs) refer to a hazy increase in lung attenuation with preservation of **bronchial and vascular margins**, often seen in various stages of interstitial pneumonia. - GGOs can reflect active **inflammation**, cellular infiltration, or mild fibrosis and are often potentially reversible.

Q: Round pneumonia is seen with

Streptococcus pneumoniae. ***Streptococcus pneumoniae*** - **Round pneumonia**, a well-defined spherical opacification on chest radiography, is a characteristic presentation of pneumonia caused by ***Streptococcus pneumoniae***, particularly in children. - The organism's ability to incite a rapid, localized inflammatory response can lead to the formation of this focal, rounded consolidation. *Kerosene oil aspiration pneumonia* - Kerosene oil aspiration typically causes a **diffuse, bilateral pneumonitis** with chemical irritation, not a well-circumscribed round lesion. - The radiographic pattern is usually one of prominent **ground-glass opacities** and consolidations, often in the lower lobes. *Mendelson syndrome pneumonia* - Mendelson syndrome, or **aspiration pneumonitis**, involves chemical lung injury from aspirating gastric contents, leading to **diffuse inflammation** and edema. - It typically presents as **patchy or diffuse infiltrates**, often bilateral and basilar, rather than a solitary round infiltrate. *Lung cancer* - While lung cancer can present as a **round mass** or nodule, it is a neoplastic process, not an infectious pneumonia. - A distinguishing feature is that lung cancer masses typically show **growth over time** and may have irregular margins or spiculation, unlike the acute inflammatory nature of round pneumonia.

Q: Finger-in-glove sign is seen in

Bronchocele. ***Bronchocele*** - The **finger-in-glove sign** is a characteristic radiological finding that represents **mucoid impaction** – a **bronchus distended with mucus**, appearing as branching, finger-like opacities. - **Bronchocele** refers to this mucus-filled, dilated bronchus caused by bronchial obstruction. - The **most common cause** of the finger-in-glove sign is **allergic bronchopulmonary aspergillosis (ABPA)**, though it can also be seen in bronchial atresia, asthma with mucus plugging, and other causes of bronchial obstruction with mucostasis. *Pulmonary alveolar proteinosis* - This condition is characterized by the accumulation of **lipoproteinaceous material within the alveoli**, not the bronchi. - Radiologically, it often presents as **diffuse ground-glass opacities** and **interlobular septal thickening**, known as a "crazy-paving" pattern, which is distinct from the finger-in-glove sign. *Pneumocystis jirovecii* - **Pneumocystis pneumonia (PCP)** typically affects immunocompromised individuals and is characterized by a diffuse **interstitial pneumonia**. - Radiological features include diffuse **ground-glass opacities**, reticular patterns, and sometimes cysts, but not the mucinous impaction seen in the finger-in-glove sign. *Tuberculosis* - Tuberculosis can manifest in various forms, including **cavitary lesions**, **nodules**, consolidation, and **pleural effusions**. - While it can cause bronchial narrowing, it does not typically lead to the distinct finger-in-glove appearance caused by mucoid impaction within dilated bronchi.

Q: Based on the provided chest X-ray image of a patient presenting with low-grade fever, which infection is most likely?

Miliary Tuberculosis. ***Miliary Tuberculosis*** - The chest X-ray shows diffuse, fine, granular infiltrates, often described as a **"millet seed" pattern**, which is highly characteristic of **miliary tuberculosis**. - This pattern represents widespread hematogenous dissemination of *Mycobacterium tuberculosis* and is consistent with systemic symptoms like **low-grade fever**. - The **uniform distribution** of 1-3 mm nodules throughout both lung fields is pathognomonic for miliary TB. *Lobar Pneumonia* - **Lobar pneumonia** appears as a homogenous opacification of a lung segment or entire lobe, often with obscuration of vascular markings and sometimes with **air bronchograms**. - The image does not show a dense, localized area of consolidation, but rather a diffuse, fine nodular pattern throughout both lung fields. - Lobar pneumonia typically presents with high-grade fever and acute symptoms, not the low-grade fever described. *Interstitial Lung Disease* - While interstitial lung disease can present with widespread infiltrates, these are typically more varied, showing patterns like **reticular nodularities**, **honeycombing**, or **ground-glass opacities**. - The uniform, fine nodularity seen in the image is not typical for most forms of interstitial lung disease. - ILD is usually a chronic process, whereas miliary TB can present acutely or subacutely. *Bronchopneumonia* - **Bronchopneumonia** commonly presents as patchy, multifocal areas of consolidation or opacities that are often centered around bronchi in a **bronchocentric distribution**. - The widespread, uniform, and fine nodular pattern seen on this X-ray is distinct from the typical patchy, asymmetric appearance of bronchopneumonia. - Bronchopneumonia shows more confluent opacities rather than discrete miliary nodules.

Q: On CT chest, the 'halo sign' is particularly associated with which condition in immunocompromised patients?

Invasive pulmonary aspergillosis. ***Invasive pulmonary aspergillosis*** - The **halo sign** on CT chest, characterized by a ground-glass opacity surrounding a nodule, is a classic radiographic finding in **invasive pulmonary aspergillosis**, especially in immunocompromised patients. - This sign represents hemorrhage around the fungal nodule and indicates active tissue invasion by *Aspergillus* species. *Pulmonary hydatid cyst* - Hydatid cysts are typically well-defined, thin-walled cystic lesions, often displaying the **water lily sign** if complicated by rupture, which is different from the halo sign. - These cysts are caused by the larval stage of *Echinococcus granulosus* and are not associated with a peripheral ground-glass opacity. *Round pneumonia* - Round pneumonia is a localized, **spherical consolidation** often seen in children, which does not typically exhibit the perilesional ground-glass opacity characteristic of the halo sign. - It usually represents bacterial infection and resolves with antibiotics, unlike the invasive fungal disease suggested by the halo sign. *Bronchiectasis* - Bronchiectasis is characterized by **irreversible dilation of the bronchi**, often appearing as "tram-track" opacities or "signet ring" signs on CT. - It is a chronic condition related to airway damage and mucus retention, and not associated with acute nodular lesions or the halo sign.

Q: Which condition is characterized by a specific appearance on CT scans that resembles small centrilobular nodules with branching linear structures?

Pulmonary tuberculosis. ***Pulmonary tuberculosis*** - This description ("small centrilobular nodules with **branching linear structures**") is characteristic of the **tree-in-bud pattern** seen on CT scans, which is a hallmark finding in active **endobronchial spread of tuberculosis**. - The tree-in-bud pattern results from the impaction of tuberculous **granulomas** and caseous material in the terminal and respiratory bronchioles. *Silicosis* - Characterized by multiple small, well-defined **nodules** (often in the upper lobes) that tend to calcify, but typically lacks the fine **branching linear structures**. - It’s associated with occupational exposure to **silica dust** and may progress to **massive progressive fibrosis**. *Pulmonary hydatid cyst* - Presents as a well-defined, usually **single, large cystic lesion** on CT, often with internal membranes if ruptured (water lily sign or crumpled membrane sign). - It does not typically manifest with small centrilobular nodules or branching linear structures. *Small cell carcinoma* - Usually appears as a **large central mass**, often with mediastinal lymphadenopathy, and sometimes associated with obstructive pneumonitis. - It does not typically present as diffuse small centrilobular nodules with branching patterns.

Q: What is the most common feature of sarcoidosis on chest X-ray?

Bilateral hilar lymphadenopathy. ***Bilateral hilar lymphadenopathy*** - **Bilateral hilar lymphadenopathy** is the hallmark radiological feature of sarcoidosis, seen in over 75% of cases. - This finding, often symmetrical, represents the accumulation of **non-caseating granulomas** in the lymph nodes. - Classic presentation in **Stage I and Stage II** sarcoidosis. *Pleural effusion* - **Pleural effusions** are uncommon in sarcoidosis, occurring in less than 5% of cases. - When present, they are usually small and unilateral, and their presence should prompt consideration of alternative diagnoses. *Cavitation* - **Cavitation** is a rare manifestation of sarcoidosis and is more characteristic of infectious processes like **tuberculosis** or certain fungal infections. - If seen, it usually suggests severe parenchymal involvement or superimposed infection. *Reticular opacities* - While **reticular opacities** (interstitial changes) can be seen in later stages of sarcoidosis, representing **pulmonary fibrosis**, they are not the *most common* initial finding. - These opacities indicate chronic disease progression (Stage III/IV) rather than the initial presentation.

Question 1

Which of the following is NOT a chest radiographic feature of left atrial enlargement?

Accepted Answer

Boot-shaped heart

Answer

Elevated left main bronchus

Answer

Splaying of carina

Answer

Enlargement of left atrial appendage

Question 2

Chest x-ray of a child presenting with acute breathlessness. What is the most likely diagnosis?

Accepted Answer

Pneumothorax

Answer

Normal

Answer

Pneumatocele

Answer

Pleural effusion

Question 3

HRCT features of interstitial pneumonia include all of the following EXCEPT:

Accepted Answer

Bronchiectatic features

Answer

Reticular opacities

Answer

Honeycombing

Answer

Ground glass opacities

Question 4

Round pneumonia is seen with

Accepted Answer

Streptococcus pneumoniae

Answer

Kerosene oil aspiration pneumonia

Answer

Mendelson syndrome pneumonia

Answer

Lung cancer

Question 5

Finger-in-glove sign is seen in

Accepted Answer

Bronchocele

Answer

Tuberculosis

Answer

Pulmonary alveolar proteinosis

Answer

Pneumocystis jirovecii

Question 6

Based on the provided chest X-ray image of a patient presenting with low-grade fever, which infection is most likely?

Accepted Answer

Miliary Tuberculosis

Answer

Lobar Pneumonia

Answer

Interstitial Lung Disease

Answer

Bronchopneumonia

Question 7

On CT chest, the 'halo sign' is particularly associated with which condition in immunocompromised patients?

Accepted Answer

Invasive pulmonary aspergillosis

Answer

Pulmonary hydatid cyst

Answer

Round pneumonia

Answer

Bronchiectasis

Question 8

Which condition is characterized by a specific appearance on CT scans that resembles small centrilobular nodules with branching linear structures?

Accepted Answer

Pulmonary tuberculosis

Answer

Silicosis

Answer

Pulmonary hydatid cyst

Answer

Small cell carcinoma

Question 9

What is the most common feature of sarcoidosis on chest X-ray?

Accepted Answer

Bilateral hilar lymphadenopathy

Answer

Cavitation

Answer

Pleural effusion

Answer

Reticular opacities

Question 10

Inferior rib notching is seen in

Accepted Answer

Coarctation of the aorta

Answer

Rickets (Vitamin D deficiency)

Answer

Atrial Septal Defect (ASD)

Answer

Multiple Myeloma

Chest Radiology — MCQs

Chest Radiology — MCQs

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