Chest Radiology Quiz

1
Chest Radiology Quiz
2
Label the parts 1. Trachea 2. Left
Clavicle 3. Aortic knuckle 4. Left Pulmonary
Artery 5. Left Hilum 6. Left heart border /
ventricle 7. Left hemi-diaphragm 8. Left
costo-phrenic angle 9. Right cardiophrenic
angle 10. Right Atrium 11. Right
hilum 12. Carina
1
2
3
12
4
5
11
6
10
7
9
8
3

• Bronchiectasis in a patient with CF
• What are the 3 types of this condition
• Cylindrical
• Varicose
• Saccular
• What is the aetiology of the condition
• CF
• Mucociliary clearance deficiency
• Bronchial wall weakness
• Prior infection
• Obstruction
• Aspiration
• Inflammation
• Impaired host defence

4

• Right Upper Lobe Consolidation
• What are the fissures of the right lung
• Oblique fissure
• Horizontal fissure
• What sign is seen in the RUL
• Air Bronchogram
• What disease is this x-ray consistent
• with
• Pneumonia
• What criteria is used to calculate an
• increased mortality from this condition

5

• Right Middle Lobe Collapse
• What does the sharp defined line
• in the right lung field represent
• Horizontal fissure
• How do you know it is not the
• lower lobe that has collapsed
• Hemi-diaphragm is well
• defined in RLL collapse
• Right heart border is usually
• well defined in RLL collapse
• Name 3 causes of lobar collapse
• Tumours

6

• Right Upper Lobe Collapse
• What does the sharp defined
• border represent
• Horizontal fissure
• What is the key feature of lobar
• collapse
• Loss of volume
• How can you tell if this film is
• rotated
• Clavicles are not in
• horizontal alignment

7

• Total Collapse of Left Lung
• What is the most likely cause of this
• in a 68 year old man
• Bronchial carcinoma
• Where is the obstruction
• Left main bronchus
• What are the radiographic features
• seen in this x-ray
• Total opacification of left
• lung field
• Tracheal deviation to left
• Mediastinal shift to left

8

• Right Pleural Effusion
• What are the features seen
• Blurred hemi-diaphragm
• Blurred right heart border
• Heart shift to left
• Meniscus
• List 5 causes of this condition
• Pneumonia
• Heart failure
• TB
• Lung infarction
• Malignancy
• Connective tissue disease (rare)
• Rheumatic fever (rare)

9

• Free Air under the hemi-diaphragms
• What does this signify
• Intra-abdominal air
• List 4 causes of this
• Perforation (Ulcer)
• Recent laparotomy
• Gas producing organism
• Penetrating abdominal trauma
• Is there cardiomegaly in this patient
• how would you tell
• No
• CTR lt50

10

• Left Tension Pneumothorax
• What features can you see
• No left visible lung markings
• Deviated trachea (to right)
• Right mediastinal shift
• Left flat hemidiaphragm
• What may have caused this in
• this patient
• Left sided central line
• insertion (you can see the
• the line placed in the Left SCA
• Why should this x-ray be rare

11

• Congestive Cardiac Failure
• What are the radiographic changes
• seen in CCF
• Cardiomegaly
• Pulmonary hilar congestion
• Bats wing appearance
• Kerley B lines
• (interstitial oedema)
• Where is the last feature on this
• X Ray
• Arrow depicts
• Name 4 causes of LHF

12

• Asbestos exposure, pleural effusion
• of left base
• What feature of this x-ray is indicative
• of asbestos exposure
• Pleural plaques on diaphragm
• and on left lung field
• What is the most likely cause of
• his pleural effusion
• Bronchial Carcinoma

13

• Chronic Emphysema
• What changes can be seen that
• are consistent with the diagnosis
• Hyperexpansion
• Flat diaphragm
• Narrow mediastinum
• What other radiological changes
• may be seen in this condition
• (not on this x-ray)
• Bullae
• Increased hilar vasculature
• indicating pulmonary
• hypertension

14

• Sarcoidosis
• What classic feature can be seen
• on this x-ray
• Bi-lateral hilar lymphadenopathy
• In what other conditions may you
• see this x-ray finding
• Lymphoma
• Pulmonary TB
• Carcinoma
• What x-ray changes may be seen in
• advanced disease
• Mid zone mottling

15

• Pneumothorax
• Is the problem on the left or right
• Left (see visceral pleura outline)
• What are some of the causes of the
• above condition
• Spontaneous
• Traumatic
• COPD
• Ruptured abscess
• What is the treatment
• Needle aspiration
• Chest drain

16

• Pneumothorax
• Is the problem on the left or right
• Right
• (Arrows depict lung edge)
• What other abnormality can you see
• Right fractured clavicle
• What may happed if this patient
• were to receive positive pressure
• ventilation
• There is a risk of developing
• a tension pneumothorax

17

• Widened Mediastinum
• What may have caused this
• Chest trauma
• Thoracic aortic aneurysm
• What other condition may the
• patient have
• Cardiac tamponade
• What is the classic triad for the
• above condition
• Becks triad
• Muffled heart sounds

18

• Trauma patient with
• right sided haemothorax
• Why can you not see a meniscus or
• a fluid level
• The patient is supine
• What can you also see on the right
• side
• Multiple fractured ribs
• Surgical emphysema
• What are the 2 most useful
• interventions for this patient
• Chest drain

19

• Left Thoracoplasty
• What is the most likely reason
• for this procedure
• Previous TB
• What was the purpose of the
• procedure
• To collapse underlying lung
• to prevent spreading of TB

20

• Lung Metastasis
• Describe the appearance
• Bi-lateral lower zone
• Widespread
• Nodular shadows

21

• Left Aspiration Pneumonitis
• What is this syndrome called
• Mendelsons syndrome
• What are the features in the LUL
• Air bronchogram
• What is this consistent with
• Consolidation
• What are some of the causes of
• this situation

22

• Pulmonary Oedema
• What is the pathophysiology of this
• condition
• Pressure gt20mmHg causes
• fluid to leak from capillaries
• into the interstitial space.
• This results in increases respiration via
• which 2 reflexs
• Vagus nerve
• Hering Breuer reflex
• When is it classically seen
• Heart failure

23

• Asthmatic
• What are the features consistent with
• this diagnosis on this x-ray
• Hyperexpanded lung fields
• Low diaphragms
• Horizontal ribs
• If a lateral film were available what
• feature / sign may you determine
• Increased AP diameter
• What are the clinical features of
• this condition when life threatening
• Cannot speak

24

• Inhaled Foreign Body
• Where is the FB
• Right main bronchus
• What may happen as a result of this
• Collapse of lung
• What other X-ray would you do and
• why
• Lateral chest to depict
• AP size of object
• Bonus point if you can guess what
• the object is..

25

• Cryptogenic Fibrosing Alveoitis
• Describe the appearance
• Bi-lateral lower zone shadowing
• Blurring of silhouettes
• Fibrous strands
• Shadows are
• Ground glass appearance
• Some nodular
• What may you classically hear on
• auscultation
• End inspiratory (showering)
• crackles
• What is the mortality of this condition

26

• Collapsed Left Lower Lobe
• What is the distinctive sign shown
• Sail sign (behind heart)
• What other sign indicated a LLL
• collapse
• Blurred left hemi-diaphragm

27

• Right Lower Lobe Collapse
• What are the features on this x-ray
• Blurred right hemi-diaphragm
• Right heart border visible
• What is the well defined upper border
• seen in the right lung field
• Oblique fissure

28

• Bronchopulmonary Aspergillosis
• What are the x-ray features seen
• Bi-lateral peri-hilar shadows
• Bronchial wall thickening
• Large thick walled cavity in the
• left mid zone containing a soft
• tissue density
• What are some of the synonyms for this
• condition
• Farmers lung
• Malt workers lung
• Cheese workers lung
• Why is bird fanciers lung not included

29

• Mass in the right upper lobe apices
• What is this likely to be
• Tumour
• What is the name for this tumour
• Pancoast tumour
• What facial features may you see
• and why
• Horners syndrome
• Sympathetic outflow obstruction
• What hand signs may you see

30

• What is the diagnosis
• Right sided tension pneumothorax
• Left middle lobe collapse
• Left subphrenic tumour
• Left upper lobe pneumonia
• Left pleural effusion
• Left Upper Lobe Pneumonia
• (air bronchogram)

31
(No Transcript)