Test: Cardiothoracic Radiology - 4 - NEET PG MCQ

The "Gold standard" technique for diagnosing arterial occlusive disease is the Digital Subtraction Angiography (DSA). Here’s why it is preferred:

• High accuracy: DSA provides detailed images of blood vessels, helping to identify blockages effectively.
• Real-time imaging: It allows doctors to see blood flow in real-time, which is crucial for diagnosis.
• Minimally invasive: Compared to traditional surgical methods, DSA is less invasive and usually involves only a small incision.
• Comprehensive evaluation: It can assess both the structure and function of the arteries, offering a complete picture of vascular health.

While other methods like Doppler ultrasound and duplex imaging are useful, they do not match the precision and detail provided by DSA. Thus, DSA remains the preferred choice for accurate diagnosis.

Inferior rib notching occurs when there is a condition affecting the blood flow to the ribs. This is most commonly associated with:

• Coarctation of the aorta: This is a narrowing of the aorta, which can lead to increased pressure in the upper body and reduced blood flow to the lower body, causing rib notching.
• Rickets: A deficiency in Vitamin D can lead to weakened bones, but it is not directly linked to inferior rib notching.
• Atrial Septal Defect (ASD): This heart defect does not typically cause rib notching.
• Multiple myeloma: This is a type of cancer that affects plasma cells and does not cause rib notching.

Therefore, the most relevant condition associated with inferior rib notching is coarctation of the aorta.

Bilateral rib notching is a condition where the ribs develop indentations on both sides. This phenomenon is primarily associated with certain heart conditions. The following points explain the primary cause:

• Coarctation of the aorta: This is a narrowing of the aorta, the main artery that carries blood from the heart. It can lead to increased pressure in the upper body and decreased flow to the lower body, causing the ribs to notch over time.
• PDA: Patent ductus arteriosus is a heart defect where a blood vessel called the ductus arteriosus fails to close after birth, potentially leading to similar effects on the ribs.
• TAPVC: Total anomalous pulmonary venous connection is a rare heart defect where the pulmonary veins do not connect normally to the heart, which can also result in rib notching.

In summary, bilateral rib notching can be seen in conditions like coarctation of the aorta, PDA, and TAPVC.

In a case where a child shows signs of respiratory distress and a vascular ring is suspected, the best investigation to perform is a CT scan. This imaging technique provides clear and detailed images of the blood vessels and surrounding structures, helping to confirm the diagnosis effectively.

Other methods, although useful in various situations, are not the preferred choice for this specific issue:

• PET scans are primarily used for detecting cancer and metabolic activity.
• MRI scans can be more time-consuming and are not as effective for vascular issues.
• Angiography is invasive and generally reserved for cases where immediate intervention is necessary.

Therefore, a CT scan is the most suitable and safe option for investigating suspected vascular rings in children.

The best investigation for an asymptomatic elderly patient with a bruit in the carotid artery is Doppler ultrasonography. This test is non-invasive and helps to assess blood flow in the carotid arteries.

• Doppler ultrasonography is safe and effective.
• It can detect narrowing or blockages in the arteries.
• Other methods, like angiography, are more invasive and not necessary for this case.

Therefore, Doppler ultrasonography provides the needed information without additional risks.

In cases of massive recurrent hemoptysis in a patient with pulmonary tuberculosis, the primary focus for angiographic treatment should be on the bronchial artery. This vascular structure is most commonly involved in the bleeding process.

• The bronchial artery supplies blood to the lungs and is often the source of significant bleeding.
• Evaluating this artery first can help identify and potentially treat the bleeding effectively.
• Other structures, such as the pulmonary artery or veins, are less likely to be the cause of hemoptysis in this context.

Increased radiolucency on one side of the chest can occur due to various conditions. Here are the factors that can lead to this change:

• Obstructive emphysema: This condition can cause the lungs to appear less dense due to trapped air.
• Pneumothorax: The presence of air in the pleural space can lead to increased radiolucency.
• Patient rotation: If a patient is not positioned correctly during imaging, it can create the illusion of increased radiolucency.

However, an expiratory film does not cause increased radiolucency. Instead, it typically shows the lungs in a less expanded state, making it easier to identify any abnormalities.

In an X-ray of a patient with emphysema, the following findings are typically observed:

• Low flat diaphragm: This is often seen as a result of lung over-inflation.
• Tubular heart: The heart may appear elongated due to the changes in the chest structure.
• Increased radiolucency: This indicates areas of less density in the lungs, which is common in emphysema.

However, one finding that is not characteristic of emphysema is:

• Decreased intercostal space: In fact, the intercostal spaces may be increased due to the lung expansion.

The following points describe thymus swelling:

• Widening of the mediastinum can be seen on an X-ray.
• It may have a sharp border, resembling a "shail" appearance.
• Administering steroids can help to reduce the size of the swelling.
• On X-ray, there may be a shift of the trachea.

All these statements are true about thymus swelling except for one.

Transesophageal echocardiography (TEE) is a useful tool in diagnosing air embolism. Here are key points about its capabilities:

• Quantification: TEE can measure the volume of air that has entered the bloodstream.
• Sensitivity: It is a highly sensitive test, meaning it can detect even small amounts of air embolism.
• Continuous Monitoring: Ongoing monitoring is essential to identify any venous embolism effectively.
• Doppler Interference: Using TEE alongside Doppler ultrasound may cause interference, affecting the accuracy of readings.

In summary, TEE is a valuable method for diagnosing air embolism, particularly in how it detects and monitors air in the bloodstream.

The characteristic X-ray finding in Atrial Septal Defect (ASD) is:

• Pulmonary plethora - This refers to an increased blood flow in the pulmonary vessels, indicating that more blood is moving towards the lungs than normal.

This finding suggests that there is a left-to-right shunt due to the ASD, leading to excessive blood flow to the lungs.

In patients with mitral stenosis, X-ray findings typically include:

• Lifting up of the left bronchus, indicating pressure from the enlarged left atrium.
• A double atrial shadow, which appears due to the enlargement of both the left and right atria.
• Obliteration of the retrosternal shadow on lateral X-rays, as the enlarged heart occupies more space.
• However, the posterior displacement of the oesophagus on a barium swallow is not commonly seen.

Thus, the correct understanding is that option C, obliteration of the retrosternal shadow on lateral X-rays, is not a typical finding associated with mitral stenosis.

The earliest feature of left atrial enlargement visible on a chest X-ray (CXR) is:

• Elevation of the left main bronchus. This means that the left bronchus appears higher than normal due to the enlargement of the left atrium.
• This change can be an early indicator of heart issues, especially those related to the left atrium.

Plethoric lung fields indicate an increase in blood flow to the lungs. This can occur in several heart conditions where blood is shunted abnormally. Here’s a brief overview of each condition:

• Atrial septal defect (ASD): This is a hole in the wall between the heart's upper chambers, leading to increased blood flow to the lungs.
• Total anomalous pulmonary venous connection (TAPVC): In this condition, the pulmonary veins do not connect normally to the heart, causing excess blood to flow into the lungs.
• Ebstein’s anomaly: A heart defect affecting the tricuspid valve, which can also lead to extra blood flow to the lungs.
• Ventricular septal defect (VSD): This involves a hole in the wall between the heart's lower chambers, leading to increased lung blood flow.

Among these, Ebstein’s anomaly is the one condition where plethoric lung fields are typically not seen. In summary, all conditions except Ebstein’s anomaly can lead to plethoric lung fields.

For a patient with a strong suspicion of pulmonary thromboembolism, the most effective investigation to conduct is:

• CT angiography: This test provides detailed images of the blood vessels in the lungs, helping to identify any blockages.
• D-dimer tests can indicate the presence of blood clots but are not definitive.
• Catheter angiography is more invasive and typically used when other tests are inconclusive.
• Colour Doppler is mainly used for examining veins and might not be suitable for diagnosing pulmonary issues.

Therefore, CT angiography is the preferred option for accurately diagnosing pulmonary thromboembolism.

For investigating pulmonary embolism, the most common and effective method is:

• Contrast CT: This type of scan provides clear images of blood vessels in the lungs, helping to identify any blockages.
• It uses a contrast dye that enhances visibility during the scan, making it easier to detect embolisms.

Other methods, like a CT scan without contrast, a ventilation-perfusion scan, or an MRI, are less effective for this specific condition.

Pulmonary embolism is a serious condition that occurs when a blood clot blocks a blood vessel in the lungs. The most effective way to diagnose this condition is through a CT scan. This imaging technique provides clear and detailed pictures of the blood vessels in the lungs, helping doctors identify any blockages caused by clots.

Other diagnostic methods include:

• Ventilation-Perfusion Scan: This test evaluates the airflow and blood flow in the lungs but is less commonly used than a CT scan.
• Ultrasound (USG): Primarily used to check for clots in the legs, which can contribute to pulmonary embolism.
• X-ray of the chest: This can help rule out other conditions but is not specific for pulmonary embolism.

In summary, a CT scan is the preferred method for diagnosing pulmonary embolism due to its accuracy and effectiveness.

When an air bronchogram is seen on a chest X-ray, it indicates the presence of an intrapulmonary lesion. This means that there is an abnormality or disease affecting the lung tissue itself. The air bronchogram appears as air-filled bronchi surrounded by fluid or consolidation, which is often due to conditions like pneumonia or other lung infections.

Calcified pulmonary metastasis is commonly associated with the following types of cancer:

• Pancreatic carcinoma often leads to distant spread and calcification in the lungs.
• Thyroid carcinoma can also cause metastasis, but it is less frequently calcified.
• Endometrial carcinoma may metastasise, but calcified lesions are not typical.
• Osteosarcoma usually does not result in pulmonary calcifications.

Among these, calcified pulmonary metastasis is primarily seen in pancreatic carcinoma.

In sarcoidosis, the main radiological features include:

• Hilar lymphadenopathy: This refers to the swelling of lymph nodes in the region of the lungs.
• Hilar lymphadenopathy with parenchymal lung changes: This involves both the swollen lymph nodes and alterations in lung tissue.
• No hilar lymphadenopathy with parenchymal lung changes: This indicates changes in lung tissue without swollen lymph nodes.

All of these features can be present in different cases of sarcoidosis, highlighting the variability of the disease.