Test: Cardiothoracic Radiology - 1 - NEET PG MCQ

In left ventricular heart failure, several radiological features can be observed. Here are the key points:

• Kerley B lines: These are thin lines seen on X-rays that indicate fluid in the lungs.
• Cardiomegaly: This refers to an enlarged heart, which is a common sign of heart failure.
• Oligemic lung fields: This term means there is reduced blood flow to the lungs, which is not typical in left ventricular heart failure.
• Increased flow in upper lobe veins: Normally, in left ventricular heart failure, blood flow in the upper lung veins may be increased due to congestion.

Among these, oligemic lung fields do not fit with the common findings in left ventricular heart failure.

The X-ray shows a clear area of increased density that blends with the right heart border. This suggests a possible infection in the lungs, specifically:

• Pneumonia in the medial zone of the right middle lobe, which is likely causing this effect.
• This type of pneumonia often appears as a shadow or opacity on X-rays, especially when it affects areas close to the heart.
• Other options may involve different lung areas or conditions that do not typically silhouette the heart border.

Thus, the most likely diagnosis is pneumonia affecting the medial zone of the right middle lobe.

To assess the position and integrity of the implantable cardioverter defibrillator (ICD), the best method is a plain radiograph. This imaging technique is effective because it allows visualisation of the ICD's placement and any potential issues, such as dislocation or damage. Other methods, like contrast CT, MRI, and USG, may be less suitable due to various factors, including the presence of metal components in the ICD, which can interfere with MRI results.

The best non-invasive method to check the viability of the myocardium is the FDG-18 PET CT. This technique allows doctors to assess the heart muscle's health and functionality without requiring any surgical procedures.

• It provides detailed images of the heart.
• It measures how well the myocardium is receiving blood.
• This method is particularly useful in identifying areas of the heart that may be damaged or not working properly.

Other options, like echocardiograms and scintigraphy methods, are valuable but may not provide the same level of detail regarding myocardial viability.

Water lily sign is a radiological feature associated with certain lung conditions. It is primarily seen in:

• Hydatid cyst of lung - This is a parasitic infection caused by tapeworms, leading to cyst formation in the lungs.
• Aspergilloma lung - This occurs when a fungal ball, often from Aspergillus species, develops in a pre-existing lung cavity.
• Tuberculosis (T.B) - A bacterial infection that can cause cavities in the lungs, where the water lily sign may appear.
• Silicosis - This is a lung disease caused by inhaling silica dust, but it does not typically show the water lily sign.
• Hamartoma lung - This is a benign tumour in the lung, which generally does not present this sign.

Among these conditions, the water lily sign is most commonly seen in Hydatid cysts.

The left border of the heart on a chest X-ray is primarily formed by the left ventricle.

Here's a breakdown of the components:

• The left ventricle is the main part that creates the left outline of the heart shadow.
• The left pulmonary artery and other structures do not significantly contribute to this border.
• The right atrium and right ventricle are located more towards the centre and right side, not affecting the left border.

Thus, when viewing a chest X-ray, the left ventricle is the key structure to identify on the left border.

Loculated pleural effusion is a condition where fluid accumulates in the pleural space, often causing specific patterns on imaging. Here are some key points about it:

• Obtuse angle: It forms an obtuse angle with the chest wall, indicating a well-defined fluid collection.
• Margins: When viewed from the side, the margins appear sharp and well-defined, not diffuse.
• Confined nature: It is often confined to specific bronchopulmonary segments, which means it does not freely flow throughout the pleural cavity.
• Air bronchograms: Unlike other fluid collections, air bronchograms may not be visible within the opacity of loculated effusions.

The best way to detect a minimal right-sided pleural effusion is by using the right lateral decubitus position. This method allows for better visibility of fluid accumulation in the pleural space.

• The right lateral decubitus position involves the patient lying on their right side.
• This position helps to separate the pleural layers, making it easier to identify any fluid present.
• Other positions, such as left lateral or left lateral decubitus, may not effectively reveal fluid on the right side.

In summary, for optimal detection of a right-sided pleural effusion, the right lateral decubitus position is recommended.

Extensive pleural thickening and calcification, particularly affecting the diaphragmatic pleura, are common characteristics of asbestosis. This condition is caused by prolonged exposure to asbestos, a material once widely used in construction and other industries.

• Asbestosis leads to lung damage and respiratory issues.
• Symptoms may include shortness of breath and persistent cough.
• Diagnosis typically involves imaging tests like X-rays or CT scans.
• Preventive measures focus on avoiding asbestos exposure.

In a newborn with a radiopaque shadow and an air-fluid level in the chest, along with herniated vertebrae of the 6th thoracic vertebra, the most likely diagnosis is:

• Congenital diaphragmatic hernia: This condition occurs when there is an abnormal opening in the diaphragm, allowing abdominal organs to move into the chest cavity, which can lead to respiratory distress.
• Oesophageal duplication cyst: This is a rare condition where a cyst forms in the oesophagus, but it usually does not present with a significant chest shadow or vertebral issues.
• Bronchogenic cyst: These are abnormal growths that can occur in the lungs but are less likely to cause significant symptoms in newborns compared to other conditions.
• Staphylococcal pneumonia: This is an infection that can cause lung problems, but it typically does not present with the specific findings described in this case.

Based on the above considerations, the congenital diaphragmatic hernia is the most fitting diagnosis due to the combination of symptoms observed.

The symptoms and findings suggest that the child is experiencing a blockage in the airway. Here’s a breakdown of the situation:

• Respiratory difficulty: This indicates that the child is struggling to breathe.
• Stridor: A high-pitched sound during breathing often caused by an obstruction in the airway.
• Decreased breath sounds and wheeze: These suggest that there may be fluid or a foreign object blocking the airways.
• X-ray findings: The right opaque hemothorax indicates the presence of blood in the pleural space, which can further obstruct breathing.

Given these signs, the most likely cause is that the child has inhaled a foreign object, leading to respiratory distress and the findings on the X-ray.

In cases of a child experiencing acute respiratory distress with hyperinflation of one lung seen on an X-ray, the most likely cause is:

• Foreign body aspiration - This occurs when an object is inhaled into the airways, leading to obstruction and difficulty in breathing.
• Other options like Staphylococcal bronchopneumonia and aspiration pneumonia typically present with different symptoms and findings on imaging.
• Congenital lobar emphysema is a rare condition and would usually be present from birth, not acute onset.

Thus, the acute nature and the unilateral lung hyperinflation strongly suggest that a foreign body is causing the respiratory distress.

A congenital diaphragmatic hernia is a condition where there is an abnormal opening in the diaphragm, allowing abdominal contents to move into the chest cavity. This can lead to serious complications, including:

• Underdevelopment of the lungs, as the space for lung growth is restricted.
• Respiratory distress due to compromised lung function.
• Potential for gastrointestinal issues as organs such as the stomach and intestines can be displaced.

Diagnosis typically involves imaging techniques like ultrasound or X-rays. Treatment often requires surgical intervention to repair the diaphragm and reposition the abdominal organs.

This situation involves the aspiration of a foreign body, and the most effective course of action is to perform a bronchoscopy to extract the foreign object. However, with the advancement of imaging methods, particularly using a low-dose CT scanner, a CT scan is typically conducted to determine the precise location.

The patient has been on bed rest and is experiencing breathlessness and chest pain, despite normal X-ray results. In this situation, it is crucial to identify any potential blood clots in the lungs.

• CT angiography is the most effective test for diagnosing pulmonary embolism, which is likely given the patient's symptoms and history.
• This imaging test provides detailed pictures of blood vessels and can quickly show blockages or clots.
• Other tests, such as a lung ventilation-perfusion scan or pulmonary arteriography, may also be considered, but CT angiography is typically preferred for its speed and accuracy.

In the context of pulmonary embolism, the key finding in a perfusion scan is:

• The presence of a perfusion segmental defect.
• A perfusion defect may occur alongside a normal lung scan and radiography.
• Other signs, such as tenting of the diaphragm, may not be directly linked to perfusion scans.
• A normal chest scan typically rules out significant issues.

Hampton hump is a feature associated with:

• Pulmonary embolism - This occurs when a blood clot blocks a blood vessel in the lungs, leading to various symptoms and complications.
• It is important to recognise this condition quickly as it can be serious.
• Diagnosis often involves imaging tests like a CT scan.

The patient has symptoms like fever, cough, and breathlessness lasting for two months. A chest scan showed:

• Bilateral upper lobe fibrotic lesions
• Enlarged necrotic nodes in the mediastinum with a peripheral rim enhancement

These findings suggest a chronic infection or inflammatory process. The most likely diagnosis in this case is: Tuberculosis (TB). TB can cause similar symptoms and the presence of fibrotic lesions and necrotic nodes supports this diagnosis.

The patient has a history of dyspnea (difficulty breathing) and a non-productive cough. The X-ray findings show bilateral perihilar opacities, which indicates a potential lung infection. Since there is no pleural effusion or lymphadenopathy, we can narrow down the possible causes. In patients with AIDS, one common opportunistic infection is caused by Pneumocystis carinii, which typically presents with these symptoms and X-ray findings.

• Tuberculosis often shows more distinct features on X-ray, such as cavitation.
• CMV (Cytomegalovirus) can cause lung issues but usually has different symptoms and X-ray appearances.
• Kaposi’s sarcoma typically presents differently and is associated with skin lesions.

Given the information, the most likely cause of the patient's symptoms is Pneumocystis carinii pneumonia.

A patient who has received a bone marrow transplant has developed a chest infection. A CT scan shows a characteristic pattern known as "tree-in-bud". This appearance is often linked to specific infections.

• Klebsiella: This bacterium can cause lung infections, especially in immunocompromised patients.
• Pneumocystis: This is a fungus that commonly affects individuals with weakened immune systems, such as transplant recipients.
• TB: Tuberculosis can lead to various lung problems, but the tree-in-bud pattern is less typical for it.
• RSV: Respiratory Syncytial Virus is known for causing respiratory infections, particularly in young children and the elderly.

Given the context of a bone marrow transplant recipient, the most likely cause of the tree-in-bud appearance is Pneumocystis pneumonia, as it is a common complication in such patients.

The patient is a 35-year-old with a history of exposure to asbestos who is experiencing chest pain. A chest X-ray has revealed a solitary pulmonary nodule located in the right lower zone. A Contrast-Enhanced Computed Tomography (CECT) scan shows that this nodule is enhancing and is situated near the right lower costal pleura. It also shows a comet tail sign and adjacent pleural thickening.

Based on these findings, the most likely diagnosis is:

• Mesothelioma: A type of cancer often linked to asbestos exposure.
• Round atelectasis: A condition where lung tissue collapses in a round shape, often associated with pleural disease.
• Pulmonary sequestration: A rare lung condition where a portion of lung tissue is not connected to the normal airways.
• Adenocarcinoma: A common type of lung cancer, but less likely in this specific case.

Considering the patient's background and the imaging characteristics, the diagnosis of round atelectasis is the most fitting.

In cases where bronchogenic carcinoma is suspected, it is essential to image the following organ:

• Adrenals - These glands can be affected by metastasis from lung cancer, making them important to examine.

The other organs listed, such as the spleen, kidney, and pancreas, are generally not prioritised for imaging in this context. Focusing on the adrenals helps in assessing the extent of the disease more accurately.

Among the cancers listed, the one that is most sensitive to chemotherapy is:

• Small cell lung cancer: This type responds well to chemotherapy treatments.
• Pancreatic cancer: Generally resistant to chemotherapy.
• Renal carcinoma: Often not very responsive to standard chemotherapy.
• Melanoma: Typically treated with targeted therapies rather than chemotherapy.

Therefore, the best choice is small cell lung cancer, as it shows significant sensitivity to chemotherapy treatments.

The dome of the diaphragm can become elevated for several reasons. Here are some common causes:

• Diaphragmatic paralysis: This occurs when the diaphragm cannot move properly, leading to an abnormal position.
• Pulmonary and lobar collapse: When parts of the lung collapse, this can push the diaphragm upwards.
• Subphrenic abscess: An infection below the diaphragm can create pressure that elevates it.
• Large pleural effusion: Accumulation of fluid in the pleural space can push the diaphragm up, causing it to appear elevated.

However, among these, a large pleural effusion is generally known to cause elevation of the diaphragm.

The term ground glass appearance is a radiological sign typically seen in certain medical conditions. It is important to understand where this appearance is not found. Here are the conditions:

• Hyaline membrane disease: This condition shows ground glass appearance due to the presence of hyaline membranes in the lungs.
• Left to right shunts: These typically do not exhibit ground glass appearance, as they affect blood flow rather than lung structure.
• Pneumonia: This condition can show ground glass opacities due to inflammation in the lungs.
• Obstructive TAPVC: This condition may also display ground glass appearance due to lung congestion.

Thus, ground glass appearance is not seen in left to right shunts.