Test: Cardiothoracic Radiology - 2 - NEET PG MCQ

Posterior mediastinal opacity can be caused by several conditions. Among these, the most relevant is:

• Bochdalek’s hernia - This is a type of congenital diaphragmatic hernia that can lead to abnormal lung development, resulting in appearances on chest X-rays.
• Tortuous innominate artery - While it can be seen on imaging, it is less likely to cause significant opacity in the posterior mediastinum.
• Enlarged pulmonary artery - This typically presents differently and is not a common cause of posterior mediastinal opacity.
• Thymoma - This is a tumour of the thymus gland, which can appear in the anterior mediastinum rather than the posterior.

Therefore, Bochdalek’s hernia is the most likely cause of posterior mediastinal opacity on chest radiographs.

The best view for a chest X-ray is the PA view. This view provides a clear image of the heart and lungs, allowing for better evaluation of any potential issues.

• The PA view helps to reduce the size of the heart in the image.
• It offers a more accurate representation of lung conditions.
• This view is standard for chest X-rays in medical practice.

Other views, such as the lateral view, can provide additional information, but the PA view is the most commonly used for initial assessments.

Pleural effusion can be characterised by the presence of fluid in the pleural cavity, often leading to:

• Increased pressure on the lung, causing breathing difficulties.
• Potential shifts in the mediastinum.
• Dependent positioning of the hemithorax affected by the effusion.

This condition may require further investigation and management to address the underlying causes and alleviate symptoms.

To detect minimal pleural effusion effectively, the best X-ray view is the lateral decubitus position. This view allows for the accumulation of fluid to be more visible, as it can settle in the dependent areas of the pleural space. The other views, such as AP and PA, may not show small amounts of fluid as clearly.

• The lateral decubitus view helps in identifying even small amounts of fluid.
• Fluid will appear as a dull area on the X-ray image.
• Other views might miss minimal effusions due to their positioning.

The minimal amount of pleural fluid that can be detected on a chest radiograph in a PA view is approximately 150 ml.

The PA perspective during complete expiration is crucial in understanding respiratory mechanics. It involves:

• Monitoring the pressures within the airway and alveoli.
• Assessing the changes in lung volumes and capacities.
• Evaluating the efficiency of gas exchange processes.

Overall, this viewpoint provides insights into how well the lungs are functioning and can indicate any potential issues that may arise during breathing.

A lung collapse, also known as a pneumothorax, occurs when air leaks into the space between the lung and the chest wall. This situation can lead to the following issues:

• Reduced lung capacity, making it difficult to breathe.
• Potential for complete lung collapse, which can be life-threatening.
• Possible sharp chest pain and rapid breathing.

Causes of a lung collapse may include:

• Injury to the chest, such as a fracture or stab wound.
• Certain medical conditions, like lung disease or infections.
• Spontaneous occurrences without an obvious reason, particularly in tall, thin individuals.

Treatment options vary depending on the severity and cause, ranging from:

• Observation in minor cases.
• Needle aspiration or chest tube insertion for larger pneumothoraces.
• Surgery in recurrent or severe situations.

Early diagnosis and intervention are crucial for effective management of a lung collapse.

Lingular is a term that often refers to something that is singular or unique in nature. It can be used in various contexts, including:

• Describing a specific instance or occurrence.
• Referring to a particular individual or entity.
• Indicating a one-of-a-kind situation or phenomenon.

In some fields, such as linguistics or mathematics, the concept of "lingular" may have specific implications:

• In linguistics, it might denote a singular grammatical form.
• In mathematics, it may relate to singular points or functions.

Understanding the nuances of the term can enhance clarity in communication, particularly in specialised discussions.

The base of the heart, comprising the right atrium (RA) and right ventricle (RV), is situated opposite to the apex.

In cases of lung consolidation, the part of the lung that can obscure the aortic knuckle on an X-ray of the chest is usually the:

• Apicoposterior segment of the left upper lobe.

This region's consolidation can lead to a loss of visibility of the aortic knuckle due to its anatomical position.

The right middle lobe of the lung plays a crucial role in respiratory function. It is located between the upper and lower lobes and has various anatomical characteristics:

• It comprises three segments: the lateral, medial, and posterior segments.
• This lobe is primarily responsible for gas exchange, facilitating the transfer of oxygen and carbon dioxide.
• It is susceptible to infections such as pneumonia, which can significantly impact respiratory health.
• Due to its position, it can be affected by conditions like atelectasis, which involves the collapse of lung tissue.

Understanding the structure and function of the right middle lobe is essential for diagnosing and treating respiratory diseases effectively.

Klebsiella pneumonia is a type of bacteria that can lead to various infections, particularly in individuals with weakened immune systems. It is known for:

• Causing pneumonia, which can result in severe respiratory issues.
• Being associated with urinary tract infections.
• Possessing antibiotic resistance, making treatment challenging.
• Spreading easily in healthcare settings, particularly among vulnerable populations.

Understanding its behaviour and resistance patterns is crucial for effective management and treatment strategies.

Unilateral hyperlucency on a chest X-ray can indicate a few conditions. Here are the primary causes:

• Poland syndrome: This is a rare congenital condition where there is an absence of chest muscle on one side, leading to hyperlucency.
• Asthma: Though it primarily affects airways, severe asthma can sometimes cause hyperlucency due to air trapping.
• Acute bronchiolitis: This condition usually affects children and can cause hyperlucency due to inflammation of the small airways.
• Pleural effusion: While this typically presents as a dull area on an X-ray, in some cases, it can contribute to the appearance of hyperlucency if there are accompanying conditions.

Among these, Poland syndrome is the most direct cause of unilateral hyperlucency.

Emphysema is a progressive lung condition that primarily affects the air sacs, known as alveoli, in the lungs. In this disorder:

• The alveoli become damaged and lose their elasticity.
• This leads to difficulty in breathing and a decrease in the lungs' ability to exchange oxygen and carbon dioxide.
• Individuals often experience shortness of breath, particularly during physical activities.
• Chronic exposure to irritants, such as cigarette smoke and air pollution, is a significant contributing factor.

While there is currently no cure for emphysema, treatment options are available to help manage symptoms and improve quality of life. These may include:

• Medications to open airways and reduce inflammation.
• Rehabilitation programmes to enhance physical fitness.
• In some cases, surgical interventions may be necessary.

Early diagnosis and lifestyle changes, such as quitting smoking, can significantly impact the progression of the disease.

A solitary nodule in the lung can be caused by various conditions. However, one of the options listed does not typically present as a solitary lung nodule. Here’s a brief overview of each option:

• Tuberculoma: This is a type of tuberculous infection that can appear as a nodule in the lung.
• Neurofibroma: This is a benign nerve sheath tumour that does not usually occur in the lungs as a solitary nodule.
• Bronchogenic carcinoma: This is a common type of lung cancer that can present as a solitary nodule.
• Lymphoma: This cancer can affect the lungs and may present as a solitary nodule.

In summary, the condition that cannot present as a solitary nodule in the lung is neurofibroma.

The signs that indicate a benign nature in the evaluation of a solitary pulmonary nodule on a CT scan include:

• Air-bronchogram within the nodule, which can suggest that the nodule is not cancerous.
• Amorphous calcification is often a sign of a non-cancerous nodule.
• Fat density inside the lesion, as fat is usually associated with benign conditions.
• Spiculated outline typically raises concerns for malignancy, hence is not a benign sign.

Among these, the presence of fat density is the most reliable indicator of a benign nodule.

The best way to investigate a solitary pulmonary nodule (SPN) seen on an X-ray is through an image-guided biopsy. This method allows for precise sampling of the nodule, providing a clear diagnosis.

Here are the reasons why an image-guided biopsy is preferred:

• Direct access: It targets the nodule directly, ensuring that the sample taken is representative.
• Minimally invasive: This procedure is less invasive compared to other methods, reducing recovery time and risks.
• Diagnostic accuracy: It provides valuable information about the nature of the nodule, helping to distinguish between benign and malignant conditions.

While other imaging techniques like a CT scan can provide more detailed images, the biopsy is essential for a definitive diagnosis.

Popcorn calcification is most commonly associated with:

• Pulmonary hamartoma, a type of benign lung tumour.
• This condition appears as rounded, popcorn-like spots on imaging scans.
• It is important to differentiate it from other conditions like tuberculosis, metastasis, and fungal infections.
• Recognition of this pattern can aid in accurate diagnosis and management.

Characteristics of a benign tumour in the lung as seen on an X-ray include:

• Size: Typically larger than 5 cm in diameter.
• Cavitation: Presence of cavities within the tumour.
• Location: Usually found in the peripheral regions of the lung.
• Calcification: Shows concentric and dense calcification patterns.

The displacement of the mediastinum towards the same side can indicate several underlying conditions. This shift is often associated with:

• Structural abnormalities in the thoracic cavity
• Pathological changes in lung volume
• Presence of significant masses or fluid accumulation

Understanding the reasons behind this shift is crucial for accurate diagnosis and management of the patient's condition.

In the context of lung collapse, there are several indirect radiological signs to consider. Here are the key points:

• Mediastinal displacement: This refers to the movement of the mediastinum towards one side, indicating a potential issue with lung volume.
• Hilar displacement: The hilum may shift due to changes in lung volume, suggesting collapse.
• Compensatory hyperinflation: This occurs when adjacent lungs expand to compensate for the collapsed lung, making it a relevant sign.
• Loss of aeration: This is a direct indicator of lung collapse, as it signifies a lack of air in the affected lung area.

Among these, the last point—loss of aeration—is a direct sign rather than an indirect one.

CT angiography is a non-invasive imaging technique that provides detailed visuals of blood vessels and tissues. It leverages computed tomography (CT) to produce cross-sectional images, which can help detect various vascular conditions.

• This method is particularly useful for identifying blockages, aneurysms, and other abnormalities in blood vessels.
• CT angiography can be performed quickly, often yielding results within a short timeframe.
• It typically requires the injection of a contrast agent to enhance the visibility of the blood vessels.
• Patients may experience a warm sensation during the injection, which is a common reaction.

Although generally safe, there are some risks associated with CT angiography, such as exposure to radiation and potential allergic reactions to the contrast material. Therefore, it is essential for healthcare providers to evaluate the benefits and risks before proceeding with the procedure.

The best method for diagnosing a pulmonary embolism is through a procedure called pulmonary catheter angiography. This test involves inserting a thin tube into the blood vessels of the lungs to take detailed images. Here are some key points:

• This method provides clear images of the blood vessels.
• It helps detect blockages or clots in the lungs.
• Other tests like chest X-rays or blood gas analysis are less effective.

Bronchoscopy is a medical procedure that allows for the examination of the airways and lungs. It is typically performed using a thin, flexible tube known as a bronchoscope, which is inserted through the nose or mouth and into the trachea.

• The procedure is primarily used to diagnose issues such as infections, tumours, or other abnormalities within the lungs.
• It can also be employed for therapeutic purposes, such as removing blockages or obtaining tissue samples for further analysis.
• Patients may be given a local anaesthetic to minimise discomfort during the procedure.
• Although bronchoscopy is generally safe, there are potential risks involved, including bleeding and infection.

Following the procedure, patients are usually monitored for a short period to ensure there are no immediate complications. Recovery time can vary, but many individuals are able to resume normal activities within a day or two.

The term floating water lily sign is commonly associated with a specific lung condition. This sign appears on imaging tests, indicating the presence of fluid or abnormal growths in the lung area. It is particularly linked to:

• Lung hydatid - a cystic infection caused by a parasite.
• Bronchial adenoma - a type of benign tumour in the lungs.
• Lung abscess - a pus-filled cavity in the lung due to infection.
• Aspergilloma - a fungal ball that can develop in pre-existing lung cavities.

Of these conditions, the floating water lily sign is most notably identified with lung hydatid disease. This characteristic appearance is due to the way the cysts float in the lung's air-filled spaces, resembling water lilies.