Chest X-ray

e. This image is normal

Athletic 24-year-old female non-smoker with palpitations. Which statement is true? a. The lungs are hyperexpanded b. Heart is enlarged c. Multiple rib fractures are visible d. Breast asymmetry indicates a previous mastectomy e. This image is normal

d. Left mid and lower zone consolidation

Chest pain in patient with permanent pacemaker inserted 2 months previously. Which radiological finding is present? a. Normal image b. Pacemaker incorrectly positioned c. Pacemaker insertion complicated by large pneumothorax d. Left mid and lower zone consolidation e. Enlarged heart

d. Lungs are hyperexpanded

Cough, weight loss, and finger clubbing. Which statement is true? a. Diagnostic image of lung cancer b. Diagnostic image of pneumonia c. Blunting of the costophrenic angles due to pleural effusions d. Lungs are hyperexpanded e. Heart is enlarged

Small cell carcinoma

What is the arrows pointing to on this chest X-ray?

Elevated intima in the descending aorta

What is the dark like indicating?

Centrilobular emphysema

What is the diagnosis of this CT?

Panlobular emphysema

What is the diagnosis of this CT?

Dilatation of the left atrium

What is the most common finding on the X-ray of a patient with chronic chest pain and CHF?

c. Trauma

What is the most likely cause of chest pain seen in this close-up chest X-ray image? a. Infection b. Cancer c. Trauma d. Fibrosis e. Sarcoidosis

Pneumonia

What is the most likely diagnosis of this X-ray?

Aortic dissection where the aorta is separated by the elevated intima

What is the potential cause this patient's acute chest pain?

Cardiomegaly and distended upper lobe pulmonary veins

What is this X-ray showing?

Kerley-B lines in the lower left lobe

What is this X-ray showing?

Areas of ground glass opacity

What represents active interstitial pulmonary disease on a CT?

Would sound like rice crispies

What sound would you hear if you were to apply pressure to a region of trauma and suspected emphysema?

c. Right side of chest hyper-resonant to percussion

Which PE sign would you expect to be present at that time of taking this X-ray? a. Left-sided bronchial breathing b. Tracheal deviation c. Right sided of chest hyper-resonant to percussion d. Normal exam findings e. Finger clubbing

b. Septal lines (Kerley B lines)

Which finding is present in this close up chest X-ray image? a. Bronchiectasis b. Septal lines (Kerley B lines) c. Accessory fissures d. Lung fibrosis e. Normal chest X-ray

d. Classified pleural plaques

Which finding is present on this detail image of the left lung? a. Mesothelioma b. Asbestosis c. Pleural effusion d. Classified pleural plaques e. Normal

c. Meniscus sign

Which finding is present on this image? a. Normal x-ray b. Sail sign c. Meniscus sign d. Pneumothorax e. Air bronchogram

a. Normal chest X-ray

Which finding is present: a. Normal chest X-ray b. Cardiomegaly c. Pectus excavatum d. Azygous fissure e. Free gas under the diaphragm

c. Pectus excavatum

Which finding is present? a. Normal b. Dextrocardia c. Pectus excavatum d. Right middle lobe pneumonia e. Cardiomegaly

1. Multiple rib fractures 2. Subcutaneous emphysema from the trauma

1. What are the arrows indicating? 2. What are the stars indicating?

1. Pneumothorax 2. Visceral pleural line

1. What do the stars indicate? 2. What do the arrows indicate?

e. Consolidation

20 year old female with high temperature and cough. Which answer best describes the appearance? a. Normal b. Image inadequate due to patient rotation c. Pleural effusion d. Lung cancer e. Consolidation

e. Normal appearances

29-year-old male- presented with cough and pleuritic chest pain. What is the radiological diagnosis? a. Metastatic disease b. Pulmonary fibrosis c. Sarcoidosis d. Surgical emphysema e. Normal appearances

b. The patient has smoked heavily for many years.

55-year-old male. Which is the most likely clinical scenario? a. Clinically suspected bowel perforation b. The patient has smoked heavily for many years c. Unilateral hyper-resonance to percussion d. Long history of cardiomegaly e. Multiple previous exposures to asbestos

c. Aspiration pneumonia

A 78-year-old woman remains in hospital 4 weeks after a stroke with residual poor swallow. She becomes SOB with a cough, high temperature and raised inflammatory markers; none of these clinical features were present at the time of admission. The X-ray appearances are most likely caused by which complication? a. Lung fibrosis b. Community acquired pneumonia c. Aspiration pneumonia d. Surgical emphysema e. Heart failure

d. Surgical emphysema

A chest drain has been inserted to treat a large pneumothorax and chest X-ray was requested to check its position. Which feature does the X-ray show? a. Normal appearances b. Correctly placed chest drain c. Cardiomegaly d. Surgical emphysema e. Inadequate image

Linear compressions that keep collapsing because the alveoli are all connected.

How do we radiologically describe the appearance of atelectasis?

Visceral pleural white line

How do you differentiate a pneumothorax from large paraseptal (subpleural) bulla?

Honeycombing appearance

How would you describe the appearance of this disease on the HRCT?

Secondary pulmonary lobule (centrilobular emphysema)

How would you describe the destruction of lung tissue that is centrally placed within the structural unit a in smoker?

Secondary pulmonary lobules (panlobular emphysema)

How would you describe the destruction of lung tissue that is more advanced and becomes a single air sac?

Black lungs because the parenchyma is destroyed and is more extensive

How would you describe this CT?

Missing tissue in the center lobules

How would you describe this CT?

a. Lungs are hyperexpanded

Longstanding heavy smoker with a dry cough. Which statement is true? a. Lungs are hyperexpanded b. Blunting of costophrenic angles is due to pleural effusions c. Heart is enlarged d. Patient is rotated to their right e. Smoking history is irrelevant to interpretation of this image.

b. Right lower zone

Middle-aged male with cough, high temperature and chest pain. Where is the acute abnormality? a. Right upper zone b. Right lower zone c. Left upper zone d. Left lower zone e. Below the diaphragm

e. Right lung

Nasogastric tube insertion with failure of attempted aspiration of gastric fluid. What is the location of the nasogastric tube? a. Stomach b. Within a hiatus hernia c. Right upper quadrant of abdomen d. Right side of the mediastinum e. Right lung

a. Immediately return to reassess the patient and alert your team of the X-ray findings

On seeing this chest X-ray, which of the following actions is most appropriate? a. Immediately return to reassess the patient and alert your team of the X-ray findings b. Request a CT of the chest with intravenous contrast c. Request an ultrasound of the abdomen d. No action is necessary - image is normal e. Request a repeat X-ray - it is under-penetrated

b. Left internal jugular catheter

PA image. Which of the following is not present? a. Cardiomegaly b. Left internal jugular catheter c. Prosthetic heart valves d. Pacemaker device e. Sternotomy wires

Pulmonary embolus

Patient presents with the following signs/symptoms: 1. Acute dyspnea 2. Pleuritic chest pain 3. Decrease arterial oxygen saturation 4. Tachycardia

e. Left lower zone

Patient with cough and fever. Which area is abnormal? a. Right upper zone b. Left upper zone c. Both middle zones d. Right lower zone e. Left lower zone

e. Primary bronchogenic lung carcinoma

Regarding this X-ray, the most likely diagnosis is... a. Sarcoidosis b. Mesothelioma c. Pulmonary fibrosis d. Thymoma e. Primary bronchogenic lung carcinoma

Kerley-B lines

Short white lines at the lung bases that are perpendicular to and meet the pleural surface at the lateral aspect of the lung in the costophrenic sulcus

e. A sign of interstitial pulmonary oedema

The radiologic feature shown is... a. Diagnostic of sarcoidosis b. Not a significant finding in the context of suspected heart failure c. Diagnostic of lymphangitis carcinomatosa d. Normal variant e. Sign of interstitial pulmonary oedema

Healed clavicle

What abnormality can you see other than the consolidation?

Small cell carcinoma

What are the arrows pointing to on this chest X-ray?

c. Tuberculosis infection

What are the chest X-ray appearances most likely due to in this patient with a cough? a. Pulmonary oedema b. Lung metastases c. Tuberculosis infection d. Previous spontaneous pneumothorax e. Sarcoidosis

1. Reticular pattern 2. Micronodular pattern 3. Reticulonodular pattern

What are three ways to describe the appearance of interstitial lung disease on a CT or X-ray?

1. Mechanical bronchial obstruction 2. Loss of surfactant

What are two causes of atelectasis?

Filling defect

What are we looking for on the CT for a suspected PE?

Cavitating squamous cell carcinoma

What can be suspected based on this chest X-ray?

Non-small cell carcinoma (adenocarcinoma)

What can be suspected based on this chest X-ray?

Non-small cell carcinoma with pleural effusion

What can be suspected based on this chest X-ray?

e. Dextrocardia with normal situs

What congenital abnormality is visible in the chest X-ray of a patient with no respiratory symptoms? a. Right-sided aortic arch b. Tetralogy of Fallot c. Dextrocardia with bronchiectasis related to Kartagener's syndrome d. Dextrocardia with situs inversus e. Dextrocardia with normal situs (situs solitus)

Consolidation in the right upper lobe

What do you see on the x-ray?

Shows fine reticular increased density at the lung bases in interstitial lung disease

What do you see on this PA chest radiograph?

Ground glass opacity that possibly is indicating active interstitial pulmonary disease

What does this CT show?

Pulmonary fibrosis

What does this HRCT show?

CT scan

What is fundamental in evaluating and diagnosing interstitial lung disease?

Atelectasis: partial collapse at the level of the alveoli

What is happening to cause this left lower lung lobe collapse?

Pulmonary embolus in the right pulmonary artery

What is most likely the diagnosis based on this CTPA?

b. Pleural effusion

What is the abnormality demonstrated radiological? a. Breast asymmetry due to previous mastectomy b. Pleural effusion c. Air bronchogram d. Bilateral hilar enlargement e. Phrenic nerve palsy

d. Any of the above

Which one statement is true? On appearances alone, the diagnosis is... a. Pneumonia b. Lung cancer c. Pulmonary contusion d. Any of the above e. Normal chest X-ray

d. Nasogastric tube should be removed

Which statement is correct? a. X-ray is of poor quality and should be repeated b. Endotracheal tube should be advanced c. Internal jugular catheter should be removed d. Nasogastric tube should be removed e. Lungs are normal

a. This image shows a finding which could be explained by recent laparoscopic surgery

Which statement is true? a. Image shows a finding which could be explained by recent laparoscopic surgery b. Urgent CT scanning is required regardless of the clinical context c. Abnormality is obvious and so a systematic approach is not required d. Image is of poor quality and should be discarded and repeated e. Heart is enlarged

e. None of the above (normal X-ray)

Which structure is abnormal? a. Heart b. Right hilum c. Aortic knuckle d. Trachea e. None of the above (normal X-ray)

d. Right paratracheal stripe

Which structure is visibly normal in this patient with lung cancer? a. Left upper zone b. Left hilum c. Left lower zone d. Right paratracheal stripe e. Right hilum

This is an AP view, so the heart cannot be accurately assessed.

Why is this image of the heart not definitively considered to be enlarged?