Chest Radiology Practice Questions

Q: Which of the following conditions is most commonly associated with eggshell calcifications?

Silicosis. **Silicosis** - **Eggshell calcifications** in hilar lymph nodes are a **pathognomonic finding** for silicosis. - This condition is caused by the inhalation of **silica dust**, leading to fibrotic changes in the lungs. *Sarcoidosis* - Characterized by **non-caseating granulomas** and can cause hilar lymphadenopathy, but typically does not manifest as eggshell calcifications. - More commonly associated with **bilateral hilar lymphadenopathy** that is symmetric and often resolves spontaneously. *Aspergillosis* - Primarily a **fungal infection** that can cause various lung manifestations, including aspergillomas and invasive aspergillosis. - Does not typically lead to **eggshell calcifications** of the lymph nodes. *Pulmonary artery hypertension* - Involves **elevated pressures in the pulmonary arteries** and is not associated with calcifications of lymph nodes. - Often manifests with **right heart enlargement** and specific vascular changes on imaging.

Q: All are radiological features of mitral stenosis except:

Oligemia of upper lung fields. ***Oligemia of upper lung fields*** - This is **NOT a feature of mitral stenosis** and is therefore the correct answer to this EXCEPT question. - Mitral stenosis causes **cephalization of pulmonary blood flow** (also called upper lobe blood diversion), which means **increased vascularity** in the upper lung fields, not oligemia (decreased blood flow). - Due to pulmonary venous hypertension, there is redistribution of blood flow from the lower lobes to the upper lobes, making the upper lobe vessels appear **more prominent**, not oligemic. - **Oligemia** (reduced blood flow) is the opposite of what occurs in mitral stenosis. *Straight left border of heart* - This is a **characteristic feature** of mitral stenosis. - Results from enlargement of the **left atrial appendage**, which straightens the normally concave left heart border. - Creates a distinctive silhouette on PA chest X-ray due to left atrial pressure overload. *Pulmonary hemosiderosis* - This is a **feature of chronic severe mitral stenosis**. - Occurs due to recurrent microhemorrhages from chronically congested pulmonary capillaries. - Hemosiderin-laden macrophages (heart failure cells) accumulate in the alveoli. - May present as fine reticulonodular opacities on chest X-ray. *Lifting of left bronchus* - This is a **classic feature** of mitral stenosis with significant left atrial enlargement. - The enlarged left atrium pushes the **left main bronchus** upward, best seen on lateral chest X-ray. - The angle between the main bronchi increases (normally 60-70°, may exceed 90° in severe cases).

Q: Best diagnostic aid for bronchiectasis is

CT scan. ***CT scan*** - **High-resolution computed tomography (HRCT)** is considered the **gold standard** for diagnosing bronchiectasis due to its ability to visualize airway dilation and wall thickening with high detail. - CT scans can accurately identify the characteristic **"signet ring" sign** (dilated bronchus adjacent to a pulmonary artery) and **lack of bronchial tapering**. *Bronchoscopy* - While useful for evaluating the airways for obstruction, performing biopsies, or obtaining samples for microbiology, **bronchoscopy** is not the primary diagnostic tool for bronchiectasis itself. - It may be indicated in cases where the cause of bronchiectasis is unclear or to rule out endobronchial lesions. *X-ray* - A **chest X-ray** can show non-specific findings such as increased bronchial markings or cystic shadows, but it is **not sensitive or specific enough** to reliably diagnose bronchiectasis. - **Early or mild cases** of bronchiectasis are often missed on a plain chest X-ray. *Bronchography* - **Bronchography**, an older technique involving the injection of contrast material into the airways, was once used for diagnosing bronchiectasis but has largely been **replaced by HRCT**. - It is an **invasive procedure** with potential complications and poorer resolution compared to modern CT imaging.

Q: The 'water lily sign' is characteristic of which condition?

Hydatid cyst of lung. ***Hydatid cyst of lung*** - The **'water lily sign'** in an **echinococcal cyst** (hydatid cyst) occurs when the **endocyst** ruptures and collapses, detaching from the pericyst. - This detached membrane floats within the cyst fluid, creating a characteristic appearance on imaging that resembles a water lily. *Aspergilloma lung* - An **aspergilloma (fungus ball)** is typically seen as a mobile mass within a pre-existing cavitary lesion, often associated with a **crescentic lucency (air crescent sign)**. - It does not present with the specific appearance of floating membranes seen in the 'water lily sign'. *Tuberculosis* - **Tuberculosis (TB)** in the lung can cause various imaging findings, including **cavitation**, consolidation, and nodules. - However, it does not typically produce the 'water lily sign', which is specific to parasitic cysts. *Silicosis* - **Silicosis** is a pneumoconiosis characterized by **multiple small nodules** in the upper lung fields and can lead to **progressive massive fibrosis**. - Its imaging findings are distinct and do not include the 'water lily sign'.

Q: Ring sign with dilated bronchi on CXR is a feature of

Bronchiectasis. ***Bronchiectasis*** - The "ring sign" on a Chest X-Ray (CXR) is characteristic of **bronchiectasis**, representing the cross-sectional view of a **dilated bronchus**. - **Bronchial wall thickening** and dilation create this appearance, often accompanied by **"tram lines"** (parallel lines corresponding to longitudinal views of dilated bronchi). *Asthma* - CXR in asthma is often normal but may show signs of **hyperinflation** or **bronchial wall thickening** in severe cases. - It does not typically present with the "ring sign" of permanently dilated bronchi. *Bronchiolitis* - This condition primarily affects the **small airways (bronchioles)** and is common in infants. - CXR findings typically include **hyperinflation**, **peribronchial thickening**, and **atelectasis**, but not dilated bronchi forming ring signs. *Candidiasis* - Pulmonary candidiasis is a fungal infection that can cause various CXR findings like **infiltrates**, **nodules**, or **cavities**. - It does not typically lead to bronchial dilation or the characteristic "ring sign" seen in bronchiectasis.

Q: The following are direct signs of lung collapse seen on a chest X-ray, which one of the following is NOT a direct sign?

Mediastinal shift. ***Mediastinal shift*** - While mediastinal shift can occur with lung collapse, it is an **indirect sign** caused by the volume loss in the affected hemithorax, pulling the mediastinum towards the collapsed lung. - Direct signs refer to changes observed *within* the collapsed lung tissue itself, such as increased density or displaced structures, whereas mediastinal shift is a secondary effect. *Crowding of the vessels* - This is a **direct sign** of lung collapse, as the pulmonary vessels become compacted due to the loss of lung volume. - The vessels appear closer together and more prominent in the area of collapse. *Loss of aeration* - This is a **direct sign** of lung collapse, as air is expelled or resorbed from the affected lung tissue, leading to increased opacity. - The collapsed lung appears denser and whiter on the X-ray compared to normally aerated lung. *Displacement of the fissure* - This is a **direct sign** of lung collapse, as the interlobar fissures are pulled towards the collapsed lobe due to volume loss. - The displacement of the fissure indicates the location and extent of the collapse.

Q: Kerley-B lines are seen when pulmonary venous pressure is what?

20 mmHg. ***20 mmHg*** - **Kerley B lines** indicate **interstitial edema** due to elevated **pulmonary venous pressure**, typically occurring when pressure exceeds 18-20 mmHg. - This level of pressure signifies early fluid transudation into the **interstitium**, making these lines visible on chest X-ray. *5 mmHg* - A pulmonary venous pressure of 5 mmHg is considered **normal** or within a healthy range. - At this pressure, there would be **no fluid transudation** into the interstitium, hence no Kerley B lines. *10 mmHg* - A pressure of 10 mmHg is still within the **normal or borderline normal range** for pulmonary venous pressure. - It is **insufficient** to cause the significant interstitial edema required for the formation of Kerley B lines. *40 mmHg* - A pulmonary venous pressure of 40 mmHg indicates **severe pulmonary edema**, often leading to **alveolar edema**. - At this high pressure, there would likely be diffuse, widespread opacities and **"bat wing" appearance**, not just isolated Kerley B lines.

Q: Which of the following conditions is most commonly associated with miliary mottling in the lungs?

Pulmonary tuberculosis. ***Pulmonary tuberculosis*** - **Miliary mottling** on chest X-ray is a classic radiographic feature of **miliary tuberculosis**, which results from hematogenous dissemination of *Mycobacterium tuberculosis* to the lungs. - The term "miliary" refers to the resemblance to **millet seeds**, with characteristic **1-3mm uniformly distributed micronodules** scattered diffusely throughout both lung fields. - These small, diffuse nodules represent widespread tiny **granulomas** formed in response to the disseminated bacilli. - **Miliary TB is the prototype condition** for true miliary mottling pattern. *Sarcoidosis* - While sarcoidosis can cause lung nodules, they are typically larger and more concentrated in the **perihilar regions** and upper lobes, often presenting as **lymphadenopathy** and discrete nodules rather than diffuse miliary patterns. - The nodules in sarcoidosis are **non-caseating granulomas**, but their distribution and size usually differentiate them from miliary tuberculosis. *Histiocytosis X* - **Pulmonary Langerhans cell histiocytosis (Histiocytosis X)** typically presents with a combination of **cysts and nodules**, predominantly in the upper and middle lung zones. - The radiological appearance is often described as **stellate nodules** and multifocal cysts, which is distinct from the fine, diffuse pattern of miliary mottling. *Pulmonary metastasis* - **Pulmonary metastases** usually appear as discrete, well-defined nodules or masses of varying sizes, often referred to as "**cannonball lesions**" if large, and are typically scattered unevenly throughout the lungs. - The metastatic lesions are generally larger and fewer in number compared to the fine, widespread micronodules seen in miliary mottling.

Q: On chest radiology, "egg-shell calcification" is seen in:

Silicosis. ***Silicosis*** - **Egg-shell calcification** on chest radiology is a classic and highly characteristic finding in **silicosis**, particularly involving the **hilar lymph nodes**. - This pattern of calcification results from the deposition of calcium in the periphery of enlarged lymph nodes. *Asbestosis* - Asbestosis typically involves **interstitial fibrosis** and the formation of **pleural plaques**, which can be calcified, but these calcifications rarely exhibit an "egg-shell" pattern. - Pleural effusions and **malignant mesothelioma** are also associated with asbestos exposure. *Coal-worker pneumoconiosis* - This condition is characterized by **small, rounded opacities** throughout the lungs, and in its severe form (**progressive massive fibrosis**), large opacities can be seen. - While calcification can occur, it is not typically in the form of "egg-shell calcification" of lymph nodes. *Berylliosis* - Berylliosis, particularly the chronic form, presents with a **granulomatous inflammation** similar to sarcoidosis. - Radiologically, it often shows **bilateral hilar adenopathy** and **interstitial infiltrates**, but "egg-shell calcification" is not a typical feature.

Question 1

Which of the following conditions is most commonly associated with eggshell calcifications?

Accepted Answer

Silicosis

Answer

Sarcoidosis

Answer

Aspergillosis

Answer

Pulmonary artery hypertension

Question 2

All are radiological features of mitral stenosis except:

Accepted Answer

Oligemia of upper lung fields

Answer

Straight left border of heart

Answer

Lifting of left bronchus

Answer

Pulmonary hemosiderosis

Question 3

Best diagnostic aid for bronchiectasis is

Accepted Answer

CT scan

Answer

Bronchoscopy

Answer

X-ray

Answer

Bronchography

Question 4

The 'water lily sign' is characteristic of which condition?

Accepted Answer

Hydatid cyst of lung

Answer

Aspergilloma lung

Answer

Tuberculosis

Answer

Silicosis

Question 5

A 70-year-old male presented with complaints of breathlessness and exhibited abnormal bronchial breath sounds on examination. What is the most probable diagnosis based on the provided X-ray image?

Accepted Answer

Metastasis

Answer

Pulmonary TB

Answer

Bronchogenic carcinoma

Answer

Sarcoidosis

Question 6

Ring sign with dilated bronchi on CXR is a feature of

Accepted Answer

Bronchiectasis

Answer

Asthma

Answer

Bronchiolitis

Answer

Candidiasis

Question 7

The following are direct signs of lung collapse seen on a chest X-ray, which one of the following is NOT a direct sign?

Accepted Answer

Mediastinal shift

Answer

Crowding of the vessels

Answer

Loss of aeration

Answer

Displacement of the fissure

Question 8

Kerley-B lines are seen when pulmonary venous pressure is what?

Accepted Answer

20 mmHg

Answer

5 mmHg

Answer

10 mmHg

Answer

40 mmHg

Question 9

Which of the following conditions is most commonly associated with miliary mottling in the lungs?

Accepted Answer

Pulmonary tuberculosis

Answer

Sarcoidosis

Answer

Histiocytosis X

Answer

Pulmonary metastasis

Question 10

On chest radiology, "egg-shell calcification" is seen in:

Accepted Answer

Silicosis

Answer

Asbestosis

Answer

Coal-worker pneumoconiosis

Answer

Berylliosis

Chest Radiology — MCQs

Chest Radiology — MCQs

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