2023 Pulmo Residents Exam

Question 1

What is the most common type of lung cancer? (Webb Thoracic Imaging: Pulmonary and Cardiovascular Radiology Third Edition, Sec. 2 Ch. 4 p. 336)

Answer 1

Adenocarcinoma

Question 2

Which of the following malignancies will most likely present with calcific pulmonary metastases? (Webb Thoracic Imaging: Pulmonary and Cardiovascular Radiology Third Edition, Sec. 2 Ch. 5 p. 502)

Answer 2

Mucinous adenocarcinoma

Calcification of metastases occurs most commonly with osteogenic sarcoma, chondrosarcoma, synovial sarcoma, thyroid carcinoma, and mucinous adenocarcinoma (Fig. 5.5). Calcification may be dense, particularly with osteogenic sarcoma, mimicking a granuloma. Calcification may persist following successful chemotherapy despite resolution of the tumor.

Question 3

Which type of tumor is most commonly associated with pleural metastases? (Webb Thoracic Imaging: Pulmonary and Cardiovascular Radiology Third Edition, Sec. 2 Ch. 5 p.540)

Answer 3

Adenocarcinoma

Question 4

Mediastinal lymph node involvement is the most common thoracic abnormality in patients with Non-Hodgkin Lymphoma. Which compartment is most often involved (75%)? (Webb Thoracic Imaging: Pulmonary and Cardiovascular Radiology Third Edition, Sec. 2 Ch. 6 p.588)

Answer 4

Superior mediastinal

Question 5

Most common form of emphysema characterized by airspace distention in the central portion of the lobule, with sparing of their more peripheral portions. This form affects the upper lobes more than the lower lobes. (Brant, 4th ed. p. 497)

Answer 5

Centrilobular emphysema

Question 6

The most important plain radiographic finding seen in patients with emphysema (Brant, 4th ed. p. 499)

Answer 6

Absent or attenuated peripheral vascular markings

Question 7

The most common etiologic factor for the development of emphysema (Brant, 4th ed. p. 498)

Answer 7

Smoking

Question 8

In traumatic injuries of the trachea and main bronchi, which is the most commonly involved part? (Brant, 4th ed. p. 492)

Answer 8

proximal main bronchi

• The fractures gen- erally involve the proximal main bronchi (80%) or distal tra- chea (15%) within 2 cm of the tracheal carina
• Penetrating tracheal injuries usually involve the cervical trachea and result from gunshot or stab wounds to the neck.

Question 9

It is the most common malignant mediastinal germ cell tumor (Webb Thoracic Imaging, 3rd ed, p690)

Answer 9

Seminoma

Question 10

The most common foregut duplication cysts can be present in any part of the mediastinum, but is most commonly located where? (Webb Thoracic Imaging, 3rd ed, p777)

Answer 10

Subcarinal

Question 11

True of intralobar pulmonary sequestration (Webb Thoracic Imaging, 3rd ed, p927)

Answer 11

Drainage via pulmonary veins in most

Does not have own pleura, Arterial supply - thoracic aorta, late childhood, Drainage vie pulmonary veins

Question 12

What lobe is most commonly affected in congenital lobar overinflation? (Webb Thoracic Imaging, 3rd ed, p897)

Answer 12

Left upper lobe

Question 13

Most commonly associated with the feeding vessel sign (Webb Thoracic Imaging, 3rd ed, p977)

Answer 13

Metastasis

The “feeding vessel sign” is present if a small pulmonary artery is seen leading directly to a nodule (Fig. 9.12). This appearance is most common with metastasis, infarct, and AVM. It is less common with primary lung carcinomas or benign lesions such as granuloma. If present, it should suggest the possibility of a vascular abnormality, but is nonspecific.

Question 14

his drug is the most common cause of pulmonary toxicity related to chemotherapy: (Webb 3rd ed., p 1619)

Answer 14

Bleomycin

Question 15

Radiation pneumonitis is most severe ______ following completion of treatment. (Webb 3rd ed., p 1624)

Answer 15

3-4 months

Question 16

It is the most frequent thoracic manifestation of asbestosis. (Webb 3rd ed., p 1649)

Answer 16

Pleural disease

Question 17

The tracheo-esophageal stripe represents the combined thickness of the tracheal and esophageal walls and intervening fat. It normally measures less than 5 mm. Thickening is most commonly seen in ___. (Brant, p. 329)

Answer 17

esophageal carcinoma

NOT esophagitis, esophageal varices

The interface of the right upper lobe (RUL) with the right lateral tracheal wall is called the right paratracheal stripe (Fig. 12.4A). This stripe should be uni- formly smooth and should not exceed 4 mm in width; thick- ening or nodularity reflects disease in any of the component tissues, including medial tracking pleural effusion. The left lateral wall is surrounded by mediastinal vessels and fat and is not normally visible radiographically. The posterior trachea can be visualized on the lateral chest (Fig. 12.4B). The pres- ence of air in the esophagus produces the tracheoesophageal stripe, which represents the combined thickness of the tracheal and esophageal walls and intervening fat. This stripe should measure less than 5 mm; thickening is most commonly seen with esophageal carcinoma.

Question 18

This is the most common accessory lung fissure. (Brant, p. 331)

Answer 18

Inferior accessory fissure

Question 19

All of the following refer to usual interstitial pneumonia, EXCEPT (Webb 3rd ed., p 1391)
a. Most common interstitial pneumonia
b. Spatial and temporal inhomogeneity
c. Subpleural sparing
d. Dense fibrosis, often with honeycombing

Answer 19

c

subpleural sparing is a feature of NSIP

Question 20

Most likely cause of unilateral upper lobe bronchiectasis? (Webb 3rd ed, p. 1911-1912)

Answer 20

tuberculosis

Question 21

This tumor frequently (65%) arises in the main, lobar, or segmental bronchi causing obstruction of the bronchial lumen, infiltration of the bronchial wall, and invasion of the adjacent lung or vessels. It is typically centrally-located and can present as a polypoid endobronchial mass on imaging. (Webb Thoracic Imaging: Pulmonary and Cardiovascular Radiology Third Edition, Sec. 2 Ch. 4 p. 359)

Answer 21

Squamous Cell Carcinoma

Question 22

Based on the AJCC TNM Staging Criteria for Lung Carcinoma, how would you stage a tumor that involves the main bronchus < 2 cm distal to the carina (without involving the carina), has regional metastases to the subcarinal nodes, and tumor nodules in the contralateral lung? (Webb Thoracic Imaging: Pulmonary and Cardiovascular Radiology Third Edition, Sec. 2 Ch. 4 p. 373-374)

Answer 22

stage IV

m1a (automatic stage IV) = tumor nodules in contralateral lung

Question 23

Which of the following characteristics suggests lung cancer in a solitary pulmonary nodule? (Webb Thoracic Imaging: Pulmonary and Cardiovascular Radiology Third Edition, Sec. 2 Ch. 4 p. 420)

a Diameter < 2 cm
b. Well-defined margins
c. Doubling time of 30 – 200 days
d. Enhancement of > 5 HU after contrast administration

Answer 23

doubling time of 30-200 days

Question 24

The feeding vessel sign is often used to describe metastatic pulmonary nodules. What does this suggest? (Webb Thoracic Imaging: Pulmonary and Cardiovascular Radiology Third Edition, Sec. 2 Ch. 5 p. 498)

Answer 24

The nodules have a hematogenous origin and this demonstrates their vascular supply

Question 25

Which of the following are findings associated with vascular metastasis? (Webb Thoracic Imaging: Pulmonary and Cardiovascular Radiology Third Edition, Sec. 2 Ch. 5 p.513, 520, & 528)

Answer 25

Pulmonary infarction

Question 26

Which of the following is considered a common cause of metastasis to the posterior mediastinum? (Webb Thoracic Imaging: Pulmonary and Cardiovascular Radiology Third Edition, Sec. 2 Ch. 5 p.534)

Breast carcinoma
Head and neck tumors
Melanoma
Abdominal tumors

Answer 26

Abdominal tumors

Question 27

Hodgkin Lymphoma typically presents with thoracic involvement at the time of diagnosis (85% of cases). Which of the following mediastinal lymph node compartments will almost always (98%) be involved? (Webb Thoracic Imaging: Pulmonary and Cardiovascular Radiology Third Edition, Sec. 2 Ch. 6 p.555)

Answer 27

Superior mediastinal

Question 28

According to the Lugano Staging Classification for Nodal Lymphoma, what is the definition of “bulky disease” in Hodgkin Lymphoma? (Webb Thoracic Imaging: Pulmonary and Cardiovascular Radiology Third Edition, Sec. 2 Ch. 6 p.552)

Answer 28

Mass greater than 15 cm or 1/3 of the transthoracic volume

Question 29

Blunting of the posterior gutter on an upright lateral chest radiograph indicates (Webb p2061)

Answer 29

At least 75 mL pleural fluid is present

Question 30

T or F

CT imaging and Hounsfield units can differentiate between transudative and exudative pleural effusions (Webb p2082)

Answer 30

False

Question 31

Findings suggestive of an extrapleural or pleural mass instead of a pulmonary parenchymal mass (Webb p2097)
a. Obtuse angle between the lesion and chest wall
b. Displacement of the pulmonary vessels away from the mass
Both A and B

Answer 31

Both A and B

Question 32

Criteria suggestive of malignant pleural disease on CT imaging, EXCEPT (Webb p2103).
a. Circumferential pleural thickening
b. Nodular pleural thickening
c. Peripheral pleural thickening
d. Pleural thickening greater than 1 cm

Answer 32

C

Question 33

DEFINITIVE radiographic finding/s in pneumothorax (Webb p2134, 2142)

Answer 33

Visceropleural line

Question 34

Radiographic evidence that may suggest pulmonary embolism (Webb 2151-2153)
Focal areas of pulmonary consolidation
Hampton hump
Westermark sign
Palla sign
All of the above

Answer 34

AOTA

Question 35

Chest radiographs in pulmonary embolism are (Webb 2154):
*
1/1
Sensitive
Specific
both or neither?

Answer 35

Neither A nor B

Question 36

Gold-standard for diagnosing pulmonary embolism (Webb 2169)

Answer 36

Catheter pulmonary angiography

Question 37

Signs suggestive of ACUTE pulmonary embolism instead of chronic embolism on CT pulmonary angiography (Webb 2176, 2184):

a. Recanalization
b. Calcification in the thrombus
c. Doughnut sign
d. Eccentric thrombus location

Answer 37

C

Acute PE is diagnosed when an intraluminal filling defect is seen, surrounded to a variable degree by contrast. An acute embolus may appear to be central within a pulmonary artery when seen in cross section (Fig. 27.10) or may be outlined by contrast when imaged along its axis (Fig. 27.11); these are the only absolutely reliable signs of acute PE. In some patients with acute emboli, an eccentric thrombus adherent to the vessel wall may be seen, but this finding is more typical in patients with chronic PE. An obstructed artery can be seen as an unopacified vessel, but this finding also may be seen with chronic emboli.

Question 38

Chronic pulmonary embolism characteristics

Answer 38

Concentric (contrast in vessel center reflecting Recanalization), small linear filling defects or webbs, may calcify, mosaic perfusion (oligemia)

Question 39

Characteristic finding in pulmonary arterial hypertension on imaging (Webb 2212)

Answer 39

Dilatation of the central pulmonary vasculature with rapidly narrowed peripheral portion

Question 40

The following are causes of primary bullous lung disease except (Brant, 4th ed. p. 501)

A. Ehlers-Danlos Syndrome
B. Marfan Syndrome
C. Sarcoidosis
D. Familial

Answer 40

C

Question 41

Imaging hallmark of tracheomalacia (Brant, 4th ed. P. 491)

Answer 41

Excessive airway collapse on expiration

A reduction in the cross-sectional area of the trachea exceeding 50% on the expiratory CT, particularly if there is a crescentic “frown-like” configuration to the trachea in cross section, is strongly suggestive of the diagnosis

Question 42

The following statements are true regarding tracheal bronchus except (Brant, 4th ed. p. 487)

A. Most patients are asymptomatic
B. Also known as bronchus suis
C. Association with congenital tracheal stenosis
D. Most often supplies the superior segment of the right lower lobe

Answer 42

D

apical segment of RUL

Tracheal bronchus or bronchus suis, so called because it is the normal pattern of tracheal branching in pigs, consists of an accessory bronchus to all or a portion of the right upper lobe that arises from the right lateral tracheal wall within 2 cm of the tracheal carina (Fig. 18.1). However, it most often supplies the apical segment of the right upper lobe. While it is usually an incidental finding on chest CT in 0.5% to 1.0% of the population, there is an association with congenital tracheal stenosis and an aberrant left PA. Most patients are asymp- tomatic.

Question 43

Type of bronchiectasis characterized by mild diffuse dilatation of the bronchi (Brant, 4th ed. p. 494)

Answer 43

Cylindric

Question 44

Autosomal recessive genetic disorder characterized by situs inversus, sinusitis and bronchiectasis (Brant, 4th ed. p. 496)

Answer 44

Kartagener syndrome

Question 45

Direct sign of small airway disease seen on HRCT (Brant, 4th ed. p. 503)

Answer 45

centrilobular nodular and tree-in-bud opacities

Question 46

Which is not an imaging finding of tracheobronchomegaly (Brant, 4th ed. p. 490)
a. Corrugated appearance of the trachea
b. On frontal radiographs, the trachea and central bronchi measure greater than 3.0 cm and 2.5 cm, respectively, in coronal diameter
c. Hyperinflated lungs and may demonstrate bullae
d. Extensive fibrosis

Answer 46

D

Question 47

This disease exhibits mediastinal lymph node enlargement with 1-2-3 pattern consisting of right paratracheal, right hilar, and left hilar node enlargement (Webb Thoracic Imaging, 3rd ed, p751)

Answer 47

Sarcoidosis

Question 48

This disease is a rare benign disorder caused by proliferation of acellular collagen and fibrous tissue within the mediastinum. Which of these is not a possible cause of this condition? (Webb Thoracic Imaging, 3rd ed, p764)

Answer 48

Fibrosing mediastinitis

Question 49

It is the absence of a lung and its bronchi and vascular supply (Webb Thoracic Imaging, 3rd ed, p897)

Answer 49

Pulmonary agenesis

Question 50

This type of congenital cystic adenomatoid malformation contain one or more cysts more than 2 cm in diameter (Webb Thoracic Imaging, 3rd ed, p868)

Answer 50

Type 1

Question 51

What lobe is most commonly affected in congenital lobar overinflation? (Webb Thoracic Imaging, 3rd ed, p897)

Answer 51

Left upper lobe

Question 52

Doubling time suggestive of cancer (Webb Thoracic Imaging, 3rd ed, p996)

Answer 52

1 month to 200 days

Question 53

Follow-up recommended for a low risk patient with a single solid nodule measuring 7mm according to the Fleischner Society 2017 guidelines

Answer 53

Follow up CT at 6-12 months

Question 54

The combination of patchy ground-glass opacities and areas of lucency in HRCT is termed the “headcheese sign” and is typical of hypersensitivity pneumonitis, in what stage of the disease? (Webb 3rd ed., p. 1557)

Answer 54

Subacute

Question 55

What HRCT finding can help differentiate hypersensitivity pneumonitis from Usual Interstitial Pneumonia (UIP) or Idiopathic Pulmonary Fibrosis (IPF)? (Webb 3rd ed., p. 1564)

Answer 55

Involves the entire cross section of the lung

Abnormalities in HP typically involve the entire cross section of lung, that is, both central and subpleural lung regions. Furthermore, abnormalities tend to have a mid-lung predominance, may predominate in the upper lungs, or may be diffuse, involving upper, mid, and lower lungs to an equal degree. This distribution is unlike that of some other diseases,
1564
particularly nonspecific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF), with which it may be confused clinically.
Another common manifestation of subacute HP is the presence of focal areas of decreased attenuation (mosaic perfusion) on inspiratory HRCT (75% to 85%; see Figs. 16.2B, 16.7, and 16.8) or air trapping on expiratory HRCT (90%; see Figs. 16.8 and 16.9). These areas usually have sharply defined margins and a configuration consistent with involvement of single lobule or multiple adjacent pulmonary lobules

Question 56

True of Simple pulmonary eosinophilia, also known as Loeffler’s syndrome except (Webb 3rd ed., p 1579)
a. Radiograph shows focal areas of transient consolidation
b. With blood eosinophilia of known cause
c. May be self-limited
d. History of asthma or atopy often present

Answer 56

B

Question 57

The characteristic coal macule of coal worker’s pneumoconiosis has a predominant ___ distribution. (Webb 3rd ed., p 1657)

Answer 57

Centrilobolular

Question 58

A patient with sinusitis and cough with occasional hemoptysis had a chest CT done showing bilateral pulmonary cavitary lesions, what is your likely diagnosis? (Webb 3rd ed., p 1688)

Answer 58

Granulomatosis with polyangiitis

Question 59

The following diseases may demonstrate diffuse alveolar hemorrhage on CT, except:
Henoch-Schonlein purpura
All of the above may cause diffuse alveolar hemorrhage.
Systemic lupus erythematous
Goodpasture’s syndrome

Answer 59

AOTA

Question 60

Crazy paving pattern on HRCT may be seen in COVID-19 pneumonia. However, a 40 year-old male patient with a negative antigen test and a nonproductive cough of 4-week duration had an HRCT done showing geographic distribution of crazy paving pattern. The heart is normal and no pleural effusion noted. What will be your primary consideration for this patient? (Webb 3rd ed., p 1723)

Answer 60

Pulmonary alveolar proteinosis

Question 61

Syndrome composed of pulmonary artery aneurysms, superior vena cava thrombosis, and thrombophlebitis. (Webb 3rd ed., p 1684)

Answer 61

Hughes-Stovin syndrome

Question 62

Features of Behcet

Answer 62

Question 63

In chest x-ray frontal view of an erect patient, blunting of the costophrenic sulcus may be seen in at least ____ml of pleural fluid. (Brant page 361)

Answer 63

175 mL

Question 64

Which of the following pairs (sign and type of atelectasis) is INCORRECT? (Webb 3rd ed., p 50).
A. Golden S sign: right upper lobe atelectasis
B. Luftsichel sign: left upper lobe atelectasis
C. Juxtaphrenic sign: lower lobe atelectasis
D. Flat waist sign: left lower lobe atelectasis

Answer 64

C

Question 65

Which is a direct radiologic sign of atelectasis? (Webb 3rd ed., p 47)

Answer 65

Displacement of fissures and as per WEBB crowding of vessel and bronchi

Question 66

This type of atelectasis is caused by airway obstruction: (Webb page 45)

Answer 66

Resorption

Question 67

In a chest x-ray PA view, when a consolidated lung obscures the border of the aortic arch, the involved lung segment must be: (Webb 3rd ed., p 39)

Answer 67

Left upper lobe

Question 68

This type of atelectasis results from the mass effect of an air or fluid collection within the pleural space on the subjacent lung. (Brant, p. 348)

Answer 68

Relaxation atelectasis / passive

Question 69

The following are radiographic characteristics of airspace disease except: (Brant, p. 347)
Air bronchograms
Nodules
Reticular densities
Poorly marginated

Answer 69

Reticular densities

Question 70

A small thin, walled gas containing space contiguous or along the visceral pleura.

Answer 70

Bleb

Question 71

Which of the following statements is incorrect? (Webb 3rd ed., p 39)

Patchy consolidation are caused by thick and tenacious secretions that spread via the pores of Kohn
Patchy consolidation is typical of bronchopneumonia
All of the above statements are correct
Mycoplasma pneumonia often results in patchy consolidation

Answer 71

A

spread via airway (NOT pores of Kohn)

Focal patchy consolidation is typical of pneumonias, endobronchial spread of TB, or endobronchial spread of tumor such as mucinous carcinoma (see Fig. 1.6). CT may show a pattern of lobular consolidation. Centrilobular nodules are seen in some cases (see Fig. 1.7).
Patchy consolidation is typical of bronchopneumonia. Pneumonias associated with this pattern (e.g., Staphylococcus, Haemophilus, Pseudomonas) are characterized by thick and tenacious secretions and spread via airways rather than the pores of Kohn. Infected secretions are typically present within the bronchi. Bronchopneumonia is also known as lobular pneumonia because of its tendency to involve individual lobules. Mycoplasma pneumonia often results in this pattern.

Question 72

All of the following refer to usual interstitial pneumonia, EXCEPT (Webb 3rd ed., p 1391)
Most common interstitial pneumonia
Spatial and temporal inhomogeneity
Subpleural sparing
Dense fibrosis, often with honeycombing

Answer 72

Subpleural sparing

Question 73

True or False

Ground glass opacities may indicate the presence of either air-space disease or interstitial disease. (Webb 3rd ed. p 1089)

Answer 73

True

Question 74

Which of the following is a necessary finding for the diagnosis of honeycombing on HRCT? (Webb 3rd ed., p 1100)

Answer 74

air-fillled subpleural cysts with thick, easily recognizable walls

Question 75

HRCT pattern showing lower lobe ground glass opacities with subpleural sparing:
(Webb 3rd ed, p. 1461-1462):

Answer 75

Nonspecific interstitial pneumonia (NSIP)

1. Honeycombing with a basal and subpleural predominance, in the absence of a known disease or exposure, is highly suggestive of UIP/IPF. Lung biopsy is uncommonly performed when HRCT shows these findings.
2. Concentric lower lobe ground-glass opacity without honeycombing suggests NSIP. In a patient with collagen- vascular disease, biopsy is uncommonly performed.
3. Subpleural sparing of abnormalities (reticulation or ground-glass opacity) strongly suggests NSIP.
4. Patchy or nodular subpleural or peribronchial consolidation is typical of OP or COP. The atoll or reversed halo sign suggests this diagnosis.
5. ARDS with typical plain film or CT findings, without known cause, may be AIP.
6. Diffuse or centrilobular ground-glass opacity in a smoker is typical of DIP or RB-ILD.
7. Cystic airspaces or ground-glass opacity may represent LIP. LIP is usually associated
   with other diseases.
   When interpreting HRCT, typical findings of an interstitial pneumonia should lead to the diagnosis of the pattern considered to be present. Although a definite diagnosis usually cannot be made, HRCT is used to predict the histology likely to be present. For example, the HRCT appearance of subpleural honeycombing indicates a “UIP pattern,” subpl eural sparing of ground-glass opacity is typical of a “NSIP pattern,” and patchy consolidation or the atoll sign indicates an “OP pattern.”

Question 76

HRCT pattern showing diffuse ground glass opacities with upper lobe predominance in a smoker:
(Webb 3rd ed, p. 1461-1462):

Answer 76

Respiratory bronchiolitis - interstitial lung disease (RB-ILD)

Question 77

HRCT pattern showing patchy subpleural or peribronchial consolidation with atoll sign aka revered Halo sign
(Webb 3rd ed, p. 1461-1462):

Answer 77

Cryptogenic organizing pneumonia

1. Honeycombing with a basal and subpleural predominance, in the absence of a known disease or exposure, is highly suggestive of UIP/IPF. Lung biopsy is uncommonly performed when HRCT shows these findings.
2. Concentric lower lobe ground-glass opacity without honeycombing suggests NSIP. In a patient with collagen- vascular disease, biopsy is uncommonly performed.
3. Subpleural sparing of abnormalities (reticulation or ground-glass opacity) strongly suggests NSIP.
4. Patchy or nodular subpleural or peribronchial consolidation is typical of OP or COP. The atoll or reversed halo sign suggests this diagnosis.
5. ARDS with typical plain film or CT findings, without known cause, may be AIP.
6. Diffuse or centrilobular ground-glass opacity in a smoker is typical of DIP or RB-ILD.
7. Cystic airspaces or ground-glass opacity may represent LIP. LIP is usually associated
   with other diseases.

Question 78

Which of the following accurately describes the thoracic abnormalities associated with rheumatoid arthritis? (Webb 3rd ed., p 1465)

Arthritis precedes lung disease in 90% of cases
Lung disease is more common in men
Interstitial pneumonia and fibrosis is the most common pulmonary manifestation
All of the above

Answer 78

AOTA

RA is commonly associated with thoracic abnormalities, including interstitial pneumonia and fibrosis (UIP, NSIP, and OP are most common), pleural effusion or pleural thickening, necrobiotic nodules, bronchiectasis, and bronchiolitis obliterans

Question 79

This syndrome is a manifestation of RA occurring in coal miners or patients with occupational exposures to silicates. It is characterized by single or multiple lung nodules ranging from a few millimeters to 5 cm in diameter, with upper lobe predominance. (Webb 3rd ed., p 1476)

Answer 79

Caplan Syndrome

Question 80

Patient with a history of childhood lower inspiratory tract adenovirus infection now complains of dyspnea on exertion. CXR shows a diminutive left hilum with increased lucency in the left lung. There is mediastinal shift towards the left. Diagnosis?

Answer 80

Bronchiolitis obliterans

Swyer-James syndrome (constrictive bronchiolitis or bronchiolitis obliterans).
The SJS (less desirable synonyms include McLeod’s syndrome, unilateral emphysema, unilateral lobar emphysema, and unilateral hyperlucent lung) is characterized by predominantly unilateral radiographic findings of BO (Fig. 23.26). It is commonly the result of lower respiratory tract infection, usually in childhood, and due to viral infection, Mycoplasma organisms, B. pertussis, or tuberculosis. Damage to the terminal and respiratory bronchioles leads to incomplete development of alveoli.

Based on the primary HRCT findings present, bronchiolitis may be classified in one of three groups, an approach that is more practical from a diagnostic standpoint than a histologic classification:
1. Bronchiolar disease associated with tree-in-bud
2. Bronchiolar disease associated with centrilobular nodules 3. Bronchiolar disease associated with mosaic perfusion

Question 81

Which of the following etiologic agents and pneumonia pattern, is incorrectly paired?
(Webb 3rd ed., ch 12)

S. pneumoniae: lobar pneumonia
S. aureus: bronchopnuemonia
Viral: interstitial pneumonia
P. jirovecii: lobar pneumonia

Answer 81

Wrong pair is P. jirovecii: lobar pneumonia

P.jiroveci : Interstitial pneumonia

Question 82

Refers to the combination of the calcified lung parenchymal lesion and ipsilateral mediastinal lymph node in pulmonary tuberculosis:
(Webb 3rd ed., p 1293)

Answer 82

Ranke complex

The host organism, under normal circumstances, will sequester the MTB organism by forming granulomas. Usually, these granulomas show caseous necrosis, a pattern characteristically, but not exclusively, associated with tuberculous infection. This initial infection has been termed the Ghon focus and usually heals by the development of a fibrous capsule around the focus of infection, which often calcifies. Shortly after the infection occurs, organisms may spread through the lymphatics to hilar and mediastinal lymph nodes, where a similar histopathologic reaction may occur. The combination of the lung parenchymal and lymph node MTB infection has been termed the Ranke complex. Organisms within the Ghon focus often gain access to the bloodstream and may disseminate to extrathoracic organs, but usually, host defenses are sufficient to prevent overt infection from developing in extrathoracic sites. Although the pulmonary, lymphatic, and extrathoracic foci of infection are usually inactive at this point, organisms remain viable and may serve as the nidus for reactivation of disease when the circumstances are favorable.

Question 83

With a 40 mm average interpleural distance in a supine radiograph, the estimated % pneumothorax using Choi method is:

Answer 83

49%

Question 84

Most likely cause of unilateral upper lobe bronchiectasis? (Webb 3rd ed, p. 1911-1912)

Answer 84

tuberculosis

CT Differentiation of Causes of Bronchiectasis
The reliability of radiographs and CT for distinguishing between different causes of bronchiectasis is limited. However, several general rules apply:
1. Lower lobe bronchiectasis is most typical of childhood infections, chronic infection of 1911
any cause, syndromes associated with impaired mucociliary clearance or immunodeficiency (see Figs. 23.18 and 23.19), chronic aspiration Young’s syndrome, yellow nails and lymphedema, alpha-1-antitrypsin deficiency, and systemic diseases (e.g., collagen-vascular diseases and inflammatory bowel disease). Lower lobe traction bronchiectasis is most common in patients with lung fibrosis, such as UIP or NSIP.
2. Bilateral upper and midlung bronchiectasis is seen most commonly in patients with CF and ABPA (see Figs. 23.2C and Figs. 23.11 to 23.14). Traction bronchiectasis in the upper lobes may be associated with sarcoidosis, tuberculosis, and chronic hypersensitivity pneumonitis.
3. Unilateral upper lobe bronchiectasis is most common in patients with tuberculosis (Fig. 23.20).
4. Central bronchiectasis is most common in patients with ABPA and CF (see Figs. 23.11 to 23.14). Also, it may be seen in tracheobronchomegaly (Mounier-Kuhn syndrome; see Chapter 22) and Williams-Campbell syndrome (Fig. 23.16).
5. Severe and extensive bronchiectasis is most common in patients with ABPA and CF (see Figs. 23.11 to 23.14).
6. Lobar bronchiectasis suggests infection or bronchial obstruction.
7. Middle lobe and lingular (anterior) bronchiectasis suggests MAC infection. Anterior lung
traction bronchiectasis may be seen in patients surviving ARDS.

Question 85

Answer 85

LYMPHANGITIC CARCINOMATOSIS

Question 86

Answer 86

FEEDING VESSEL SIGN

Question 87

Answer 87

S SIGN OF GOLDEN

Question 88

Answer 88

AZYGOS FISSURE

Question 89

Answer 89

MESOTHELIOMA

Question 90

Answer 90

CYLINDRICAL BRONCHIECTASIS

Question 91

Answer 91

SABER SHEATH TRACHEA

Question 92

Answer 92

HALO SIGN

Question 93

Answer 93

PULMONARY ARTERIOVENOUS MALFORMATION

Question 94

Answer 94

7

Question 95

Answer 95

ASBESTOSIS

May also be the answers:
ASBESTOS-RELATED PLEURAL DISEASE
PLEURAL PLAQUE
FIBROTHORAX

Question 96

Answer 96

WEGENER GRANULOMATOSIS
GRANULOMATOSIS WITH POLYANGIITISG

Question 97

Answer 97

BEHCET DISEASE

Question 98

Answer 98

KLEBSIELLA PNEUMONIAE

Question 99

Answer 99

PULMONARY SEQUESTRATION

Question 100

Answer 100

SPLIT PLEURA SIGN, EMPYEMA THORACIS

Question 101

Answer 101

BRONCHUS SUIS

Question 102

Answer 102

CERVICOTHORACIC SIGN

Neurogenic tumors occurring in the superior mediastinum commonly show a finding termed the “cervicothoracic sign” on plain radiographs. The sign is said to be present if a mediastinal mass shows a sharply marginated border, outlined by lung, above the level of the clavicles. Only posterior mediastinal masses show this finding. Above the level of the clavicles, anterior and middle mediastinal masses enter the neck and are no longer outlined by lung (i.e., they no longer have a sharply marginated border). - WEBB 3e p.812

Question 103

Answer 103

PNEUMOMEDIASTINUM

Question 104

Answer 104

CRAZY PAVING PATTERN

The combination of GGO and interlobular septal thickening is termed crazy paving (see Fig. 10.32). This appearance is nonspecific and may be seen with a variety of acute lung diseases such as Pneumocystis or viral pneumonia, edema, hemorrhage, and acute lung injury. Among patients with chronic lung disease, it is a classic finding for PAP, although it may be seen in any chronic infiltrative lung disease characterized by GGO.