Test: Cardiothoracic Radiology - 3 - NEET PG MCQ

In the context of an anterior mediastinal mass, the following conditions are typically considered:

• Teratoma: A type of tumour that can contain different types of tissue.
• Neurogenic tumour: These tumours arise from nervous tissue.
• Thymoma: A tumour originating from the thymus gland.
• Lymphoma: A cancer that affects the lymphatic system.

However, one of the options is not a differential diagnosis for an anterior mediastinal mass.

The most common mass found in the middle mediastinum is a lymph node mass. This area can contain various structures, but lymph nodes often enlarge due to infections or diseases.

Other potential masses in this region include:

• Lipoma - a benign fat tissue growth, less common here.
• Aneurysm - a bulging blood vessel, which can occur but is not as frequent.
• Congenital cysts - fluid-filled sacs present from birth, also not as typical.

In summary, while there are various types of masses that may appear, the lymph node mass is the most frequently encountered in the middle mediastinum.

Soft tissue masses in the chest accompanied by rib erosion can indicate various conditions. Here are the key points regarding these conditions:

• Leukemia: This blood cancer can cause masses but typically does not show rib erosion on X-rays.
• Ewing's sarcoma: This bone cancer often presents with soft tissue masses and can cause rib erosion.
• Multiple myeloma: This cancer affects plasma cells and can lead to rib erosion along with soft tissue masses.
• Osteosarcoma: This is a bone cancer that can also present with soft tissue masses and rib erosion.

Among these conditions, leukemia is the least likely to show rib erosion on X-ray.

The size of the cardiac silhouette can increase in various conditions, but there are exceptions. Here are the conditions listed with regards to increased cardiac silhouette size:

• Tetralogy of Fallot: This condition generally does not lead to an enlarged heart silhouette.
• Pericardial effusion: This is when fluid builds up in the pericardial space, causing the heart to appear enlarged on X-rays.
• Aortic regurgitation: This condition can lead to an enlarged heart silhouette due to volume overload.
• Ebstein anomaly: This heart defect can also cause the heart to appear enlarged.

Among these, Tetralogy of Fallot is the exception where an increased cardiac silhouette size is not typically observed.

The sequestrated lung, which is a part of the lung that has lost its blood supply, is primarily supplied by the bronchial artery. This artery provides oxygenated blood to the lung tissues, even when the pulmonary artery is not functioning properly.

Other arteries, such as the subclavian artery, pulmonary artery, and aorta, do not play a significant role in supplying blood to a sequestrated lung. Therefore, the bronchial artery is essential for maintaining the health of this affected lung tissue.

The features of left atrial enlargement on a chest X-ray typically include:

• Double left heart border: This indicates that the left atrium is enlarged.
• Elevated left main bronchus: The enlargement can push the bronchus upwards.
• Splaying of carina: The angle between the main bronchi may widen due to the enlarged atrium.
• Enlargement of left atrial appendage: This is a direct result of left atrial enlargement.

Among these, the correct answer is that all listed features are associated with left atrial enlargement. However, if one must choose which is less commonly emphasised, it would be the elevation of the left main bronchus as a primary indicator.

The earliest sign of left atrial enlargement is:

• Posterior displacement of the oesophagus.
• Widening of the carinal angle.
• Elevation of the left bronchus.
• Double shadow of the right heart border.

Among these signs, the posterior displacement of the oesophagus is the first indicator that suggests left atrial enlargement. This occurs because an enlarged left atrium can push the oesophagus backwards, which can be observed on imaging studies.

High-resolution computed tomography (HRCT) of the chest is particularly beneficial for assessing the following:

• Interstitial lung disease: This imaging technique provides detailed images of the lung tissue, helping to identify abnormalities and patterns associated with various interstitial lung diseases.
• Pleural effusion: While HRCT can show fluid around the lungs, it is not the best initial test for this condition compared to ultrasound.
• Lung mass: HRCT can help characterise lung masses, but other imaging techniques may also be used for a comprehensive evaluation.
• Mediastinal adenopathy: HRCT can reveal enlarged lymph nodes in the mediastinum, but the clinical context is essential for interpretation.

In summary, HRCT is most effective for identifying and understanding interstitial lung disease due to its capability to provide fine detail of lung structures.

The best method to diagnose Bronchiectasis is through high-resolution computed tomography, commonly known as HRCT. This imaging technique provides detailed pictures of the lungs and can identify structural changes associated with bronchiectasis effectively.

• HRCT is superior to standard X-rays for detecting lung abnormalities.
• It helps in assessing the extent and severity of the condition.
• Early detection can lead to better management and treatment options.

The radiological features associated with mitral stenosis include:

• Straight left border of heart: This indicates enlargement of the heart.
• Oligemia of upper lung fields: This refers to reduced blood flow in the upper areas of the lungs.
• Pulmonary hemosiderosis: This condition involves iron deposits in the lungs due to bleeding.
• Lifting of left bronchus: This can occur due to pressure changes in the chest.

However, the presence of oligemia in the upper lung fields is not a typical feature of mitral stenosis. Instead, other signs, such as pulmonary congestion, are more common.

The earliest sign of pulmonary venous hypertension visible on a chest X-ray is cephalization of pulmonary vascularity. This means that the blood vessels in the lungs appear more prominent in the upper parts of the lungs compared to the lower parts.

Other common findings that may appear later include:

• Pleural effusion - fluid accumulation in the pleural space.
• Kerley B lines - indicative of interstitial oedema.
• Alveolar pulmonary oedema - fluid in the alveoli, leading to difficulty in breathing.

However, it's important to note that cephalization is typically the first change noticed in cases of this condition.

Venous hypertension can lead to various changes in the body. The earliest sign of this condition is:

• Upper lobar vessel dilatation: This indicates that the blood vessels in the upper part of the lungs are expanding due to increased pressure.
• Kerley B lines: These are thin lines seen on X-rays, indicating fluid in the lungs, often caused by venous hypertension.
• Left atrial enlargement: This is an increase in size of the left atrium of the heart, often due to back pressure from the lungs.
• Pleural effusion: This is the accumulation of fluid in the pleural space around the lungs, which can also occur with venous hypertension.

Understanding these signs helps in early diagnosis and management of venous hypertension.

In congestive cardiac failure, several signs can be observed. However, one sign is not typically associated with this condition:

• Kerley-B lines: These are indicative of fluid in the lungs.
• Prominent lower lobe vessels: This can show increased blood flow in the lungs.
• Pleural effusions: This refers to excess fluid in the chest cavity.
• Cardiomegaly: This is the enlargement of the heart.

Among these, the condition that is not seen in congestive cardiac failure is the prominent lower lobe vessel.

The "egg-on-a-string" appearance seen on a chest X-ray is typically associated with uncorrected transposition of the great arteries (TGA). This condition occurs when the aorta and pulmonary artery are switched, leading to improper circulation of oxygenated and deoxygenated blood.

Key points about this condition include:

• The heart's structure is abnormal, which affects blood flow.
• It can lead to significant health issues if not treated.
• Diagnosis often involves imaging techniques like X-rays.

Other conditions listed do not typically present with this specific X-ray appearance.

Pruning of the pulmonary arteries typically occurs in cases of pulmonary hypertension. This condition involves an increase in blood pressure within the lungs' arteries, leading to changes in their structure and function. Below are other conditions that do not usually cause this change:

• Chronic bronchitis: This primarily affects the airways and does not lead to artery pruning.
• Pulmonary infections: While they can cause inflammation, they do not usually result in pruning.
• Pulmonary transplant: This involves replacing the lungs and doesn't typically involve pruning of the arteries.

Thus, the primary condition associated with pruning is pulmonary hypertension.

The 'Coeur en Sabot' shape of the heart is commonly associated with Tetralogy of Fallot. This condition includes four specific heart defects that affect how blood flows through the heart and to the rest of the body.

• It causes a blockage in the right ventricle, making it harder for blood to exit the heart.
• There is a hole between the ventricles, known as a ventricular septal defect.
• The aorta is positioned over the hole instead of over the left ventricle.
• The right ventricle is thicker than normal due to increased workload.

These features lead to the characteristic 'Coeur en Sabot' appearance on imaging studies.

The objective sign of identifying pulmonary plethora in a chest radiograph is related to the diameter of the pulmonary arteries. Here are the key points:

• Examine the diameter of the main pulmonary artery.
• A diameter greater than 16 mm indicates potential pulmonary plethora.
• Other arteries, such as the left and right pulmonary arteries, can also be assessed, but the main pulmonary artery is the most significant indicator.

The most common feature of Aortitis on a chest X-ray is the presence of calcification in the ascending aorta. This can indicate inflammation of the aorta, which may be associated with various conditions.

• Calcification in the ascending aorta is typically more visible and significant.
• Calcification can be a sign of chronic inflammation or damage.
• Other areas, such as the descending aorta or pulmonary artery, are less commonly affected.

Recognising these patterns is crucial for proper diagnosis and management.

In a stress echocardiogram (ECHO), a drug is used to simulate the effects of exercise on the heart. The most commonly used drug for this purpose is:

• Dobutamine: This medication increases heart rate and contractility, making it ideal for stress testing.
• Thallium, Adrenaline, and Adenosine are not typically used in this context.

Thus, Dobutamine is the preferred choice for performing a stress ECHO.

The best method to investigate an aortic dissection is through a:

• CT scan - This imaging test provides detailed images of the aorta and can quickly identify any tears or dissections.
• Aortography, MRI, and X-ray chest are less commonly used for this purpose.

The CT scan is preferred because it is fast, non-invasive, and highly effective in diagnosing aortic conditions.

The isotope commonly used in a myocardial perfusion scan is Thallium. This radioactive material helps to assess blood flow to the heart muscle.

Another option is Technetium, which is also used in some heart scans, but Thallium is more traditional for this specific procedure.

Both isotopes work by being injected into the bloodstream and highlighting areas of the heart that may not be receiving enough blood.

• Thallium: Preferred for myocardial perfusion scans.
• Technetium: Sometimes used, but less common.
• Both help in identifying heart issues through imaging.

The best test for detecting reversible myocardial ischaemia is:

• Thallium scan: This scan uses a small amount of radioactive material to assess blood flow to the heart during rest and stress.
• MUGA scan: This test evaluates the heart's pumping function but is not primarily used for ischaemia detection.
• Resting ECHO: An echocardiogram at rest shows heart structure and function but may miss ischaemia signs.
• Coronary angiography: This is an invasive procedure that visualises blood vessels but is not a stress test.

Among these, the Thallium scan is the most effective for identifying reversible conditions.

• Late enhancement seen on Gd MRI indicates the presence of scar tissue in the heart muscle.
• In cases of akinetic myocardium, revascularisation does not provide benefits, making this statement false.
• Low dose dobutamine can be used to assess hibernating myocardium, helping to stimulate heart function.
• Rest stress thallium imaging is a method used to evaluate hibernating myocardium, providing insights into the heart's condition.

In patients with Down's syndrome scheduled for surgery, it is essential to assess their heart condition. This is because individuals with Down's syndrome often have congenital heart defects.

The most appropriate investigation to perform is:

• Echocardiography: This test uses sound waves to create images of the heart, helping to identify any structural issues.

Other investigations such as CT brain, ultrasound abdomen, or X-ray cervical spine are not routinely required in this context.

The most precise method for evaluating ventricular function is through MRI. This technique provides detailed images of the heart's structure and function. Here are some reasons why MRI is preferred:

• High resolution: MRI offers clear and detailed images.
• No radiation: Unlike other imaging methods, MRI does not expose patients to harmful radiation.
• Functional assessment: It can assess how well the heart is pumping and how blood flows through it.

In comparison, other methods like echocardiography and nuclear scans may not provide the same level of detail or may involve radiation. Thus, MRI is considered the best choice for assessing ventricular function.