Chest Radiology Practice Questions

Q: Water bottle heart is seen in which of the following conditions?

Pericardial effusion. **Explanation:** **Pericardial effusion** is the correct answer. The "Water Bottle Heart" sign (also known as the "Leather Bottle" or "Flask-shaped" heart) occurs when a large amount of fluid accumulates in the pericardial sac. Due to gravity, the fluid collects in the dependent portions of the pericardium, causing the lower part of the cardiac silhouette to bulge outward while the superior mediastinum remains narrow. This creates a globular, symmetric enlargement of the heart shadow on a Chest X-ray, resembling an old-fashioned water flask. **Why other options are incorrect:** * **Patent Ductus Arteriosus (PDA):** Typically presents with features of left-to-right shunt, leading to left atrial and left ventricular enlargement, along with increased pulmonary vascular markings, rather than a symmetric globular shape. * **Chronic Emphysema:** Characterized by a "Tubular" or "Drip-shaped" heart. The hyperinflated lungs compress the heart and cause the diaphragm to flatten, making the heart appear narrow and elongated. * **Constrictive Pericarditis:** The heart size is usually normal or small. The classic radiological finding is **pericardial calcification** (best seen on a lateral view), not massive enlargement. **High-Yield Pearls for NEET-PG:** * **Minimum fluid for X-ray detection:** At least 200–250 ml of fluid must accumulate before the cardiac silhouette enlarges on a PA view. * **Echocardiography:** This is the gold standard and most sensitive initial investigation for diagnosing pericardial effusion. * **Epicardial Fat Pad Sign:** On a lateral X-ray, a vertical opaque line (pericardial fluid) sandwiched between two radiolucent fat lines (epicardial and paracardial fat) is highly suggestive of effusion. * **Electrical Alternans:** The classic ECG finding associated with a large effusion/tamponade due to the "swinging" of the heart in the fluid.

Q: Westermark's sign, Hampton's hump, and Palla's sign are all characteristic radiological findings suggestive of which condition?

Pulmonary Embolism. **Explanation:** The correct answer is **Pulmonary Embolism (PE)**. While a chest X-ray is often normal in PE (the most common finding being sinus tachycardia on ECG or a normal CXR), specific signs can point toward the diagnosis: 1. **Westermark’s Sign:** Focal oligemia (decreased vascular markings) distal to the occluded pulmonary artery due to mechanical obstruction of blood flow. 2. **Hampton’s Hump:** A wedge-shaped, pleura-based opacification with its apex pointing toward the hilum. This represents pulmonary infarction. 3. **Palla’s Sign:** Enlargement of the right descending pulmonary artery, appearing as a "sausage-shaped" shadow, caused by the presence of a large thrombus. **Why other options are incorrect:** * **Tubercular Pleural Effusion:** Typically presents with a "meniscus sign" (obliteration of costophrenic angles) and may show associated lung parenchymal lesions or hilar lymphadenopathy. * **Acute Pulmonary Edema/LVF:** These present with bilateral, symmetrical findings such as **Kerley B lines**, peribronchial cuffing, "Bat-wing" hilar opacities, and cardiomegaly. **NEET-PG High-Yield Pearls:** * **Gold Standard Investigation:** CT Pulmonary Angiography (CTPA). * **Most Common CXR Finding:** Normal CXR or non-specific atelectasis/pleural effusion. * **Knuckle Sign:** Similar to Palla’s sign, referring to the abrupt tapering of a pulmonary artery due to an embolus. * **Fleischner Sign:** Prominent central pulmonary artery due to massive PE. * **McConnell's Sign:** A specific **Echocardiographic** finding (RV free wall akinesia with sparing of the apex).

Q: Lucent hemithorax is due to all the following except?

Lung Collapse. ### Explanation **Lucent hemithorax** refers to a chest X-ray finding where one side of the chest appears darker (more radiolucent) than the other. This occurs due to either increased air (hyperinflation), decreased blood flow (oligemia), or chest wall abnormalities. **Why Lung Collapse is the Correct Answer:** Lung collapse (atelectasis) leads to an **opaque (white) hemithorax**, not a lucent one. When a lung collapses, air is resorbed, and the lung tissue becomes dense and solid. This increased density absorbs more X-rays, resulting in a radio-opaque appearance. Additionally, there is an ipsilateral shift of the mediastinum toward the side of the collapse. **Analysis of Incorrect Options:** * **Rotation:** This is a technical artifact. If the patient is rotated, the side further from the film appears more lucent due to the decreased thickness of the chest wall musculature the X-rays must penetrate. * **Swyer-James-McLeod Syndrome:** This is a post-infectious obliterative bronchiolitis. It results in air trapping and reduced vascularity (pruning of vessels) in one lung, leading to a classic hyperlucent hemithorax. * **Foreign Body:** A non-opaque foreign body in a bronchus can act as a **"check-valve,"** allowing air in during inspiration but preventing it from leaving during expiration. This leads to obstructive emphysema and a lucent hemithorax on the affected side. **High-Yield Clinical Pearls for NEET-PG:** * **Macleod’s Syndrome:** Look for a small/normal-sized lung with hyperlucency and decreased vascular markings. * **Poland Syndrome:** A rare cause of lucent hemithorax due to the congenital absence of the pectoralis major muscle. * **Pneumothorax:** A common cause of lucent hemithorax where there is a complete absence of bronchovascular markings. * **Westermark Sign:** Focal peripheral lucency (oligemia) seen in Pulmonary Embolism.

Q: What is not a CT finding in bronchiectasis?

Crazy paving appearance. **Explanation:** Bronchiectasis is defined as the permanent, abnormal dilatation of the bronchi. High-Resolution Computed Tomography (HRCT) is the gold standard for diagnosis. **Why "Crazy Paving" is the correct answer:** **Crazy paving appearance** refers to thickened interlobular septa and intralobular lines superimposed on a background of ground-glass opacification. It is a non-specific finding but is classically associated with **Pulmonary Alveolar Proteinosis (PAP)**, Lipoid pneumonia, or ARDS. It is not a feature of bronchiectasis, which primarily involves the airways rather than the alveolar/interstitial space in this specific pattern. **Analysis of other options:** * **Signet ring appearance:** This is the hallmark of bronchiectasis. It occurs when the dilated bronchus is larger than its accompanying pulmonary artery (broncho-arterial ratio >1). * **Tree-in-bud appearance:** This represents impaction of mucus, pus, or fluid in the distal bronchioles. It is frequently seen in infectious etiologies of bronchiectasis (e.g., Tuberculosis or MAC). * **Traction bronchiectasis:** This occurs when surrounding parenchymal **lung fibrosis** pulls the bronchial walls apart, leading to irregular dilatation. It is a common secondary finding in end-stage interstitial lung disease. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** HRCT Chest. * **Types of Bronchiectasis (Reid Classification):** Cylindrical (most common), Varicose, and Cystic (most severe). * **Tram-track signs:** Parallel opacities representing thickened bronchial walls (seen on X-ray and CT). * **Finger-in-glove sign:** Represents mucoid impaction, often seen in Allergic Bronchopulmonary Aspergillosis (ABPA).

Q: A patient presents with chronic productive cough and clubbing with coarse rales on auscultation. What is the diagnosis suggested by the CT scan findings shown below?

Bilateral saccular bronchiectasis. ***Bilateral saccular bronchiectasis*** - The clinical triad of **chronic productive cough**, **digital clubbing**, and **coarse rales** is classic for bronchiectasis, representing dilated and thickened airways. - CT shows characteristic **"signet ring" sign** and **dilated bronchi** that are wider than accompanying pulmonary arteries, confirming saccular bronchiectasis. *Miliary tuberculosis* - Presents with **systemic symptoms** like fever, weight loss, and night sweats, which are not mentioned here. - CT shows **small nodular opacities** (2-3mm) distributed throughout both lungs in a miliary pattern, not saccular dilatation. *Multiple cavitating secondaries* - Typically presents with **constitutional symptoms** and a known **primary malignancy** history. - CT shows **multiple round lesions** with central cavitation, not the dilated bronchial pattern seen in bronchiectasis. *Interstitial fibrosis* - Characterized by **progressive dyspnea** and **dry cough** rather than productive cough. - CT shows **honeycombing**, **traction bronchiectasis**, and **reticular opacities** in lower lobes, not saccular bronchiectasis.

Q: A 42-year-old female smoker with a 20-pack-year history is admitted with progressive shortness of breath. On examination, she has distant heart sounds with decreased breath sounds on lung exam bilaterally. No summation gallop is heard. ECG shows low voltage. Chest x-ray findings are shown. Which of the following findings on the chest x-ray may be associated with this presentation?

Positional change of chest x-ray findings. ***Positional change of chest x-ray findings*** - In **large pericardial effusion**, the cardiac silhouette can change shape and position with patient positioning due to fluid redistributing around the heart, creating the **"swinging heart" appearance**. - This finding, combined with **distant heart sounds**, **low voltage ECG**, and bilateral decreased breath sounds in a smoker, strongly suggests a **massive pericardial effusion** compressing surrounding structures. *Pericardial rub on auscultation* - **Pericardial friction rub** is typically heard in **acute pericarditis** when inflamed pericardial layers rub against each other. - In **large pericardial effusions**, the rub is usually **absent** because the fluid separates the pericardial layers, preventing friction. *Hamman's crunch on physical exam* - **Hamman's crunch** is a crepitant sound synchronous with heartbeat, characteristic of **pneumomediastinum** (air in mediastinum). - This finding is associated with **esophageal rupture** or **pneumothorax**, not pericardial effusion, and would not explain the distant heart sounds. *Continuous diaphragm sign on chest x-ray* - The **continuous diaphragm sign** indicates **pneumomediastinum** where air outlines the diaphragm continuously across the mediastinum. - This radiological finding is seen with **air in the mediastinum**, not fluid accumulation in the pericardial space as suggested by this clinical presentation.

Q: The CT chest of the patient shows the presence of which of the following?

Bronchiectasis. ***Bronchiectasis*** - CT chest shows characteristic **signet ring sign** (dilated bronchus with adjacent pulmonary artery) and **tram-track sign** (parallel bronchial walls). - Bronchi demonstrate **lack of normal tapering** and appear dilated with **thickened walls**, often in a cylindrical or varicose pattern. *Pneumatoceles* - Appear as **thin-walled air-filled cysts** within the lung parenchyma, typically following pneumonia or trauma. - Show **smooth, thin walls** without the bronchial pattern or wall thickening seen in bronchiectasis. *Normal scan* - Would show **normal bronchial tapering** with bronchi becoming progressively smaller toward the periphery. - Absence of **bronchial wall thickening**, cystic changes, or abnormal bronchial dilatation patterns. *Loculated empyema* - Presents as **loculated pleural fluid collections** with **enhancing pleural surfaces** on contrast-enhanced CT. - Shows **pleural thickening** and **septations** within the pleural space, not bronchial abnormalities.

Q: Ground glass appearance is not typically seen in which of the following conditions?

Left to right shunts. **Explanation:** Ground-glass opacity (GGO) in chest radiology refers to a hazy increase in lung opacity that does not obscure the underlying bronchial structures or pulmonary vessels. It typically represents partial filling of alveoli or thickening of the interstitium. **Why Left to Right Shunts is the correct answer:** In **Left to Right shunts** (like ASD, VSD, or PDA), there is increased pulmonary blood flow (**active hyperemia**). This manifests radiologically as prominent, well-defined pulmonary vessels (plethora) extending to the periphery. It does not cause alveolar filling or significant interstitial haze in its typical state, thus it does not present with a ground-glass appearance. **Analysis of Incorrect Options:** * **Hyaline Membrane Disease (RDS):** Characteristically presents with a diffuse, fine "ground-glass" appearance and air bronchograms due to widespread alveolar collapse (micro-atelectasis) from surfactant deficiency. * **Pneumonia:** Early stages of viral, mycoplasma, or *Pneumocystis jirovecii* pneumonia often present with GGOs before progressing to frank consolidation. * **Obstructive TAPVC:** This condition leads to severe **pulmonary venous congestion** and edema. The rapid accumulation of fluid in the interstitium and alveoli creates a classic diffuse ground-glass pattern, often described as a "white-out" in neonates. **High-Yield Clinical Pearls for NEET-PG:** * **TAPVC Classification:** Type I (Supracardiac) is the most common and shows the "Snowman" or "Figure of 8" sign. Type III (Infracardiac) is usually obstructive and presents with GGO/edema. * **GGO vs. Consolidation:** If the underlying vessels are obscured, it is consolidation; if they are visible, it is GGO. * **Common GGO Triggers:** Pulmonary edema, alveolar proteinosis, and hypersensitivity pneumonitis.

Q: What is the cause of unilateral hypertranslucent hemithorax?

Poland's syndrome. **Explanation:** A **unilateral hypertranslucent hemithorax** occurs when one side of the chest appears darker (more radiolucent) than the other on a chest X-ray. This is caused by either an increase in air (lung pathology) or a decrease in soft tissue thickness (chest wall pathology). **Why Poland’s Syndrome is correct:** Poland’s syndrome is a congenital anomaly characterized by the **unilateral absence of the pectoralis major muscle** (and sometimes the pectoralis minor). Because there is less soft tissue to attenuate the X-ray beams on the affected side, the underlying lung appears hypertranslucent despite the lung parenchyma being normal. **Analysis of Incorrect Options:** * **Pleural Effusion:** This involves fluid accumulation in the pleural space, which increases density. It presents as a **unilateral opaque (white)** hemithorax with a meniscus sign. * **Pneumonectomy:** The surgical removal of a lung leads to an **opaque hemithorax** over time as the empty space fills with fluid and the mediastinum shifts toward the affected side. * **Lung Collapse (Atelectasis):** Collapse leads to loss of aeration and increased density of the lung tissue, resulting in a **radio-opaque (white)** appearance, not hypertranslucency. **NEET-PG High-Yield Pearls:** * **Differential Diagnosis for Hypertranslucent Hemithorax:** * *Technical:* Patient rotation. * *Chest Wall:* Poland’s syndrome, radical mastectomy. * *Lung:* Pneumothorax (absence of bronchovascular markings), Swyer-James-MacLeod syndrome (post-infectious obliterative bronchiolitis), Obstructive emphysema (e.g., foreign body). * **Poland’s Syndrome Association:** Often associated with **syndactyly** or brachydactyly of the ipsilateral hand. * **Westermark Sign:** Focal hyperlucency due to oligaemia distal to a pulmonary embolism—a classic radiological sign to remember.

Q: Which of the following findings is NOT seen on HRCT in usual interstitial pneumonia (UIP)?

Ground glass opacities. **Explanation:** The diagnosis of **Usual Interstitial Pneumonia (UIP)** on High-Resolution Computed Tomography (HRCT) is defined by specific morphological features that reflect chronic, irreversible fibrosis. **Why Ground Glass Opacities (GGO) is the correct answer:** While GGOs can occasionally be present in UIP, they are **not** a defining or predominant feature. If GGOs are extensive or exceed the extent of reticulation, an alternative diagnosis (such as NSIP or Hypersensitivity Pneumonitis) should be considered. In UIP, the pathology is dominated by established fibrosis rather than active alveolar inflammation. **Analysis of Incorrect Options:** * **Honeycombing (A):** This is the **hallmark** and most specific finding of UIP. It represents destroyed and fibrotic lung tissue containing cystic air spaces with thick walls, typically arranged in layers. * **Bibasilar subpleural reticular opacities (B):** UIP characteristically follows a **craniocaudal gradient** (worse at the bases) and a peripheral distribution (subpleural). Reticular opacities represent fine interlacing lines caused by interstitial thickening. * **Traction bronchiectasis (C):** This refers to the irregular dilatation of bronchi caused by the surrounding parenchymal fibrosis "pulling" the airways open. It is a key sign of architectural distortion in UIP. **High-Yield Clinical Pearls for NEET-PG:** * **UIP Pattern:** Subpleural, basal predominance + Reticular opacities + Honeycombing (with or without traction bronchiectasis). * **Clinical Correlation:** UIP is the radiological/pathological pattern seen in **Idiopathic Pulmonary Fibrosis (IPF)**. * **Key Exclusion:** The presence of pleural effusions, significant lymphadenopathy, or extensive micronodules points away from a UIP diagnosis. * **Management:** UIP/IPF is generally poorly responsive to steroids; antifibrotic agents (Nintedanib, Pirfenidone) are preferred.

Question 1

Water bottle heart is seen in which of the following conditions?

Accepted Answer

Pericardial effusion

Answer

Patent ductus arteriosus

Answer

Chronic emphysema

Answer

Constrictive pericarditis

Question 2

Westermark's sign, Hampton's hump, and Palla's sign are all characteristic radiological findings suggestive of which condition?

Accepted Answer

Pulmonary Embolism

Answer

Tubercular pleural effusion

Answer

Acute Pulmonary edema

Answer

Left ventricular failure

Question 3

Lucent hemithorax is due to all the following except?

Accepted Answer

Lung Collapse

Answer

Rotation

Answer

Swyer-James McLeod Syndrome

Answer

Foreign Body

Question 4

What is not a CT finding in bronchiectasis?

Accepted Answer

Crazy paving appearance

Answer

Tree in bud appearance

Answer

Signet ring appearance

Answer

Traction bronchiectasis with lung fibrosis

Question 5

A patient presents with chronic productive cough and clubbing with coarse rales on auscultation. What is the diagnosis suggested by the CT scan findings shown below?

Accepted Answer

Bilateral saccular bronchiectasis

Answer

Miliary tuberculosis

Answer

Multiple cavitating secondaries

Answer

Interstitial fibrosis

Question 6

A 42-year-old female smoker with a 20-pack-year history is admitted with progressive shortness of breath. On examination, she has distant heart sounds with decreased breath sounds on lung exam bilaterally. No summation gallop is heard. ECG shows low voltage. Chest x-ray findings are shown. Which of the following findings on the chest x-ray may be associated with this presentation?

Accepted Answer

Positional change of chest x-ray findings

Answer

Pericardial rub on auscultation

Answer

Hamman's crunch on physical exam

Answer

Continuous diaphragm sign on chest x-ray

Question 7

The CT chest of the patient shows the presence of which of the following?

Accepted Answer

Bronchiectasis

Answer

Pneumatoceles

Answer

Normal scan

Answer

Loculated empyema

Question 8

Ground glass appearance is not typically seen in which of the following conditions?

Accepted Answer

Left to right shunts

Answer

Hyaline membrane disease

Answer

Pneumonia

Answer

Obstructive total anomalous pulmonary venous connection (TAPVC)

Question 9

What is the cause of unilateral hypertranslucent hemithorax?

Accepted Answer

Poland's syndrome

Answer

Pleural effusion

Answer

Pneumonectomy

Answer

Lung collapse

Question 10

Which of the following findings is NOT seen on HRCT in usual interstitial pneumonia (UIP)?

Accepted Answer

Ground glass opacities

Answer

Honeycombing and loss of lung architecture

Answer

Bibasilar subpleural reticular opacities

Answer

Traction bronchiectasis

Chest Radiology — MCQs

Chest Radiology — MCQs

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