ESA 3 - Respiratory - Session 10 - Radiology

Question 1

A 28 year old man has fever, cough and pleuritic chest pain. His chest x-ray is shown above

The most likely diagnosis is

1. Right upper lobar pneumonia
2. Right upper lobe collapse
3. Right sided pleural effusion
4. Left pneumothorax

Answer 1

1. Right upper lobar pneumonia

There is an area of opacification in the right lung with a sharp lower border which corresponds to the horizontal fissure (i.e. the opacification is in the right upper lobe),
• These features taken with the history is suggestive of a right upper lobar pneumonia.
• (If present, an air bronchogram would be an additional feature of a lobar pneumonia. However there is no obvious air bronchogram in this image.)
• There is no tracheal shift

2. Right upper lobe collapse – False ; There is no tracheal shift or other features
3. Right sided pleural effusion – False; pleural effusion collects in the dependant part of the chest. ( See Question 3 for features of a pleural effusion, and question 7 for comparison of pneumonia and pleural effusion)
4. Left pneumothorax – False; See Question 2 for features of Pneumothorax; Although the left
   upper zone looks darker than the rest of the lung fields, there are lung markings extending to
   the periphery of the lung and no evidence of collapse of the left lung.
   Also this diagnosis would not explain the obvious area of opacification in the right upper
   zone.

Question 2

A 28 year old man has sudden onset breathlessness and chest pain. His chest x-ray shown above.

The most likely diagnosis is:

1. Right middle lobe consolidation
2. Right upper lobe collapse
3. Pulmonary embolism
4. Right sided pneumothorax

Answer 2

1. Right middle lobe consolidation

Question 3

A 55 year old man complained of breathlessness. He has clinical features suggestive of a left
sided pleural effusion.

Which radiological features of a pleural effusion are seen in the chest x-ray?

1. A dense homogenous opacity
2. A concave upper border to the effusion
3. The upper border of the effusion is higher laterally than medial
4. The costo-phrenic angle on the affected side is usually lost (i.e. not seen)
5. All of the above features are seen in this x-ray

Answer 3

E. All of the above

Question 4

What life threatening condition does this CXR show evidence of?

1. Cardiac failure
2. Tension Pneumothorax
3. Pulmonary embolism
4. Perforated peptic ulcer

Answer 4

4. Perforated peptic ulcer

Question 5

A 42 year old woman with a cough of 2 months duration and low grade fever.

What is the most likely diagnosis?

1. COPD
2. Asthma
3. Pneumothorax
4. Tuberculosis
5. Pleural effusion

Answer 5

D. Tuberculosis

Question 6

What are the yellow arrows pointing to?

1. The upper border of a pleural effusion
2. The 4th rib
3. The horizontal fissure
4. The diaphragm
5. The oblique fissure

Answer 6

1. The upper border of a pleural effusion

Question 7

Chest x-rays A and B are from two patients, both of whom presented with cough and breathlessness, and have abnormal clinical signs on the left side of the chest.

Which of the following combinations correctly identifies the condition in each Chest x-ray?

(Chest x-ray A, Chest X-ray B)

1. Left lobar pneumonia; Left lobar pneumonia
2. Left pleural effusion; Left lobar pneumonia
3. Left lobar pneumonia; Left pleural effusion
4. Left pleural effusion; Left pleural effusion

Answer 7

2. Left pleural effusion; Left lobar pneumonia

Question 8

A 65 year old man with a history of smoking since the age of 18 has a chronic cough and breathlessness. His chest x-ray is shown below. Given the appearance of the chest x-ray, what is the most likely diagnosis?

1. Bronchial carcinoma
2. Lung metastases
3. Chronic obstructive airways disease
4. Cardiac failure
5. Pneumothorax

Answer 8

A. Bronchial carcinoma