Chest Imaging - Lung Diseases MCQs

Mucor mycosis can involve nose, sinuses, orbit, central nervous system (CNS), lung (pulmonary), gastrointestinal tract (GIT), skin, jaw bones, joints, heart, kidney, and mediastinum (invasive type), but ROCM is the commonest variety. It should be noted that term ROCM refers to the entire spectrum ranging from limited sino nasal disease (sino-nasal tissue invasion), limited rhino-orbital disease (progression to orbits) to rhino-orbital-cerebral disease (CNS involvement). The area of involvement may differ due to underlying condition. Reference: Singh, Awadhesh Kumar et al. “Mucor mycosis in COVID-19: A systematic review of cases reported worldwide and in India.” Diabetes & metabolic syndrome vol. 15,4 (2021): 102146. doi:10.1016/j.dsx.2021.05.019

Unilateral hemithorax in a child with sudden breathing difficulty suggests foreign body in lungs. It is removed by rigid bronchoscope, not partial. Focal areas of reduced air entry can also occur in collapse; it doesn't confirm the diagnosis. Ball valve mechanism occurs in partial obstruction not complete.

Kerley A lines are Perihilar Lines Kerley B lines are thin horizontal parallel lines perpendicular to pleura at base of Lung Kerley lines on a chest X-ray are thin linear opacities that can be associated with congestive heart failure (CHF). They are often classified into three types: Interstitial Kerley B Lines: Appear as short, horizontal lines at the lung periphery. Indicate interstitial edema, common in CHF. Septal Lines (Kerley A Lines) Vertical lines extending from the hila to the periphery. Result from fluid accumulation in the interlobular septa. Peribronchial Cuffing (Kerley A Lines): Short lines near the hila, representing fluid around bronchi. Suggestive of peribronchial edema. In CHF: X-ray findings often include cardiomegaly (enlarged heart). Increased vascular markings due to fluid retention. Pleural effusions may be present.

In Tetralogy of Fallot (TOF), there is a characteristic decrease in pulmonary vascularity(pulmonary oligemia ) rather than pulmonary plethora. This is due to the obstruction of the right ventricular outflow tract (pulmonary stenosis), which results in decreased blood flow to the lungs. As a result, there is reduced vascularity in the lung fields, which can be seen on a chest X-ray. The "boot-shaped heart" appearance on chest X-ray is due to the right ventricular hypertrophy and narrowing of the pulmonary artery, which causes the heart to take on a boot-like shape. Right ventricular hypertrophy occurs because the right ventricle has to work harder to pump blood through the narrowed pulmonary valve. The upward pointed cardiac apex is typically seen in TOF with displaced to the left and may appear rounded or boot-shaped.

Bronchi alveolar carcinoma resembles pneumonia on a chest x ray It has aerogenous spread,along the bronchial wall called lepidic growth On X-ray, bronchoalveolar carcinoma (BAC) may manifest as a peripheral lung nodule or mass, often with hazy increased density known as ground-glass opacity. These nodules may show air bronchograms, and in some cases, multifocal involvement or pleural changes might be visible. While X-ray provides initial insights, further imaging and histopathological examination are crucial for a conclusive diagnosis. CT angiogram sign is also seen in bronchoalveolar ca

Answer- B. Swyer-James-MacLeod syndrome Swyer-James-MacLeod syndrome or unilateral h erlucent lun ndrome is a rare entity associated with postinfectious bronchiolitis obliterans occurring in childhood. It is characterized by hypoplasia and/or agenesis of the pulmonary arteries resulting in pulmonary parenchyma hypoperfusion, showing a characteristic radiological pattern, such as translucent or hyperlucent unilateral lung.

Computed tomography (CT) imaging is considered to be the most effective method for detection of lung abnormalities, especially in the early stage of the disease. Moreover, serial chest CT imaging with different time intervals is also effective in estimating the evolution of the disease from initial diagnosis to discharge from hospital Reference: Wasilewski, Piotr G et al. “COVID-19 severity scoring systems in radiological imaging - a review.” Polish journal of radiology vol. 85 e361-e368. 17 Jul. 2020, doi:10.5114/pjr.2020.98009

FB aspiration is most often seen in infants and toddlers (8 months-3 years). The clinical presentation may be acute while more often the symptoms remain indolent. The symptoms and signs can mimic asthma, upper respiratory infection, or pneumonia. The history of aspiration is often not elicited. FB may lead to partial ("ball-valve" effect) or complete obstruction, resulting in hyperinflation or collapse, respectively. Chest radiograph findings include asymmetric lung aeration, lung consolidation or atelectasis, and even pneumothorax or pneumomediastinum. Inspiratory radiographs alone may be normal in up to a third of patients (14-35%) with FBs. The lung volume of the affected lung/segment may be normal, increased, or decreased. Reference: AIIMS-MAMC-PGI's Comprehensive textbook of diagnostic radiology, pg 1052