RadCases Plus Q&A Thoracic Imaging (eBook)

Case Questions and Answers

The questions and answers in the following section are numbered as cases 1 through 100. The questions correspond to the respectively numbered case reviews and are intended to be answered after working through the cases.

■ Case 1

1. Which of the following features favors an intralobar sequestration?

a) Diagnosed as a neonate

b) Situated in the lower lobes/lung bases

c) Systemic arterial supply

d) Pulmonary venous drainage

e) Communication with the bronchial tree

The correct answer is (d). In contradistinction to extralobar sequestrations, intralobar sequestrations have pulmonary venous drainage.

2. Which of the following regarding extralobar sequestrations is true?

a) Mostly present clinically with recurrent pneumonia

b) Typically not symptomatic until adulthood

c) Can be associated with other congenital anomalies such as diaphragmatic hernia

d) Usually found in the right upper lobe

e) Only occurs in males

The correct answer is (c). Extralobar sequestrations are often associated with other congenital anomalies such as diaphragmatic hernia and congenital heart disease.

■ Case 2

1. What is the most common location of a bronchogenic cyst?

a) Within the lung parenchyma

b) In the neck

c) Abutting the diaphragm

d) Within the esophageal wall

e) Near the carina

The correct answer is (e). Approximately 85% of bronchogenic cysts occur within 2 cm of the carina.

2. Which of the following regarding bronchogenic cysts is true?

a) They always have homogeneous water attenuation.

b) Mild contrast enhancement is expected.

c) The signal intensity on T1-weighted MR images is variable.

d) They usually cause symptoms.

e) Bacterial superinfection is common.

The correct answer is (c). The signal intensity on T1-weighted images is variable, depending on the presence of mucus, protein, or hemorrhage within the cyst.

■ Case 3

1. What best describes the vascular anatomy of a pulmonary arteriovenous malformation (AVM)?

a) Abnormal communication between the bronchial artery and the pulmonary vein

b) Abnormal communication between the pulmonary artery and the pulmonary vein

c) Abnormal dilatation of the pulmonary vein

d) A large dilated pulmonary capillary

e) Aneurysmal dilatation of the pulmonary artery

The correct answer is (b). Pulmonary AVMs are abnormal communications between the pulmonary artery and vein with no intervening capillary network.

2. Which of the following regarding hereditary hemorrhagic telangiectasia is true?

a) It is inherited as an autosomal-recessive disorder of variable penetrance.

b) Stroke is the most common presentation.

c) It may first present with recurrent epistaxis.

d) Presence of a pulmonary AVM is a mandatory diagnostic criterion.

e) Bronchoscopy is the preferred diagnostic modality.

The correct answer is (c). Recurrent epistaxis is due to abnormal blood vessels in the nasal mucosa and is a common clinical presentation (50–80%).

■ Case 4

1. What is the most common type of congenital pulmonary airway malformation (CPAM)?

a) Large cyst

b) Mixed

c) Small cyst

d) Microcystic

e) Macrocystic

The correct answer is (a). Large cyst (> 2 cm)–type CPAM is the most common type, comprising 50 to 70% of cases.

2. What is the most common complication of CPAM?

a) Malignant transformation

b) Oligohydramnios

c) Respiratory distress

d) Recurrent infection

e) Coexistent congenital anomalies

The correct answer is (c). Large CPAMs may compromise respiration and/or cause pulmonary hypoplasia.

■ Case 5

1. Which of the following supports a diagnosis of teratoma?

a) Elderly patient

b) Pulmonary nodules

c) Pericardial effusion

d) Paraneoplastic syndrome

e) Internal foci of fat

The correct answer is (e). On CT, internal foci of fat are seen in 75%.

2. Which of the following is unexpected in teratomas?

a) Midline location

b) Metastatic disease

c) Calcification

d) Soft tissue enhancement

e) Rim enhancement

The correct answer is (b). Pulmonary metastases are not expected with most teratomas. The most common type is a mature teratoma, which has benign features.

■ Case 6

1. Which of the following imaging findings related to a solitary pulmonary nodule favor malignancy?

a) Dense calcification

b) Smooth margins

c) Size > 2 cm

d) Popcorn calcification

e) Patient < 30 years old

The correct answer is (c). In general, the smaller the nodule, the more likely it is to be benign. Even though size > 2 cm is not indicative of malignancy, 80% of benign nodules are < 2 cm in diameter. The other choices all favor benign etiologies.

2. Which of the following regarding solitary pulmonary nodules is true?

a) Calcified nodules are never malignant.

b) When > 2 cm, metastases are usually also present.

c) A spiculated margin favors a malignant etiology.

d) Stability over 6 months is indicative of a benign etiology.

e) Several infections can present as solitary pulmonary nodules but are usually cavitary.

The correct answer is (c). A nodule with a spiculated margin with distortion of adjacent vessels is likely to be malignant.

■ Case 7

1. Where are the intrathoracic abnormalities found in α1-antitrypsin (AAT) deficiency typically localized?

a) Central airways

b) Upper lobes

c) Lower lobes

d) Mediastinum

e) Pleura

The correct answer is (c). Patients with AAT deficiency have panlobular emphysema, which is localized to the lower lobes.

2. What is the etiology of AAT deficiency?

a) Cigarette smoking

b) Asbestos exposure

c) Chronic infection

d) Drug toxicity

e) Genetic abnormality

The correct answer is (e). AAT deficiency is inherited by autosomal co-dominant transmission. Affected individuals must inherit an abnormal AAT gene from each parent.

■ Case 8

1. Where are the intrathoracic abnormalities found in α1-antitrypsin deficiency typically localized?

a) Superior mediastinum

b) Abutting the superior vena cava

c) Superior segment of the left lower lobe

d) Lung apex

e) Right middle lobe

The correct answer is (d). A superior sulcus tumor is a non–small-cell lung carcinoma arising from the lung apex and invading the chest wall or soft tissues of the thoracic inlet.

2. Which of the following is not a component of Horner syndrome?

a) Ptosis

b) Miosis

c) Anhidrosis

d) Mydriasis

e) Sympathetic nerve invasion

The correct answer is (d). Mydriasis refers to dilated pupils and is not a component of Horner syndrome.

■ Case 9

1. Which of the following imaging findings related to small-cell lung cancer (SCLC) suggest advanced disease?

a) Collateral neck and chest wall veins

b) Involvement of the mediastinum

c) An enlarged supraclavicular lymph node

d) Hoarseness

e) Pleural effusion

The correct answer is (e). In general, extensive disease is defined by disease beyond the ipsilateral hemithorax, which may include malignant pleural or pericardial effusion or hematogenous metastases.

2. Which of the following regarding SCLC is true?

a) Has a better prognosis than non–small-cell lung cancer

b) Is usually treated with surgery

c) Typically manifests as a peripheral mass

d) May secrete hormones

e) Shows slow growth

The correct answer is (d). SCLC, like other neuroendocrine tumors, may produce metabolically active substances...