CHEST CHEST RADIOLOGY QUIZ RADIOLOGY QUIZ

FOR B.C.G.FOR B.C.G.

VIVEK PATELVIVEK PATEL

Case 1Case 1

• A 23 y/ male presented with acute onset A 23 y/ male presented with acute onset of left sided chest pain and of left sided chest pain and breathlessness. breathlessness.

• Went to a physician who got an X-ray Went to a physician who got an X-ray chest PA which showed gross left sided chest PA which showed gross left sided pleural effusion. pleural effusion.

• The effusion was tapped approx. one and The effusion was tapped approx. one and half lit.half lit.

• Within 24 hrs. again fluid filled up and a Within 24 hrs. again fluid filled up and a repeat X-ray chest follows.repeat X-ray chest follows.

A follow up X-ray after A follow up X-ray after refilling of pleural effusion. refilling of pleural effusion.

A CT scan was advised A CT scan was advised

A CT guided Bx was A CT guided Bx was carried out carried out

• Diagnosis????Diagnosis????

• A correct A correct differential differential diagnosis will also diagnosis will also be given points. be given points. Maximum of three Maximum of three d/ds are allowed.d/ds are allowed.

Case 2Case 2

• A 36 yr. male patient presented with A 36 yr. male patient presented with dry cough and progressive dry cough and progressive exertional breathlessness. exertional breathlessness.

• An HRCT was advised.An HRCT was advised.

HRCT HRCT

CASE 2 CASE 2

• What is the DIAGNOSIS.What is the DIAGNOSIS.

• No d/ds are allowed. No d/ds are allowed.

CASE 3CASE 3

• A 70yr./ Female presented with left A 70yr./ Female presented with left sided haemorrhagic effusion. sided haemorrhagic effusion.

• Pleural fluid cytology for malignant Pleural fluid cytology for malignant cells was negative. cells was negative.

• Patient was operated for Carcinoma Patient was operated for Carcinoma of soft palate before 20 yrs. of soft palate before 20 yrs.

• Was advised a CT scan. Was advised a CT scan.

X-ray Chest X-ray Chest

CT scanCT scan

CT scan (contd.)CT scan (contd.)

What is the diagnosis????What is the diagnosis????

• Differentials are allowed (max. 3) Differentials are allowed (max. 3) • If the first differential is correct, full If the first differential is correct, full

marks will be awarded. marks will be awarded. • If second or third d/d is correct 50% If second or third d/d is correct 50%

marks will be awarded. marks will be awarded. • If more than 3 d/d are sent, will be If more than 3 d/d are sent, will be

disqualified. disqualified.

CASE 4CASE 4

• A 46 yr/male presented with right A 46 yr/male presented with right sided chronic chest pain and effusion. sided chronic chest pain and effusion. Patient had occupational history of Patient had occupational history of working with false ceilings in the gulf working with false ceilings in the gulf for almost 30 yrs. At present he had for almost 30 yrs. At present he had retired. retired.

• An ICD was placed.An ICD was placed.• Pleural fluid was straw coloured and Pleural fluid was straw coloured and

didn’t show any malignant cells. didn’t show any malignant cells. • Was advised a CT scan. Was advised a CT scan.

X-ray chestX-ray chest

CT scanCT scan

CT scan (contd.)CT scan (contd.)

CASE 4CASE 4

• DIAGNOSIS ????DIAGNOSIS ????• A complete diagnosis is required.A complete diagnosis is required.• d/d not allowed.d/d not allowed.

CASE 5CASE 5

• A 57 yr./male had c/o dry cough and A 57 yr./male had c/o dry cough and wt. loss.wt. loss.

• Was being treated for pulmonary Was being treated for pulmonary koch’s for past four months without koch’s for past four months without significant response. significant response.

X-ray chest X-ray chest

H.R.C.T.H.R.C.T.

CT SCAN (contd.)CT SCAN (contd.)

CASE 5CASE 5

• DIAGNOSIS?????DIAGNOSIS?????

• No d/d allowedNo d/d allowed

CASE 6CASE 6

• A 44 Yyr./male patient was referred A 44 Yyr./male patient was referred to a neurologist for severe headache. to a neurologist for severe headache.

• CSF examination was abnormal but CSF examination was abnormal but not fitting into T.B. or pyogenic not fitting into T.B. or pyogenic meningitis. meningitis.

• Patient’s HIV was negative. Patient’s HIV was negative.

CHEST X-RAYCHEST X-RAY

H.R.C.T.H.R.C.T.

CT scan (contd.)CT scan (contd.)

CASE 6CASE 6

• DIAGNOSIS ????DIAGNOSIS ????• Maximum 3 d/d are allowed.Maximum 3 d/d are allowed.• If the first of the three d/ds is If the first of the three d/ds is

correct, full marks will be awarded. correct, full marks will be awarded. If second or the third d/d is correct If second or the third d/d is correct 50% marks will be awarded.50% marks will be awarded.

CASE 7CASE 7

• A 39yr./male had c/o chronic cough A 39yr./male had c/o chronic cough with two episodes of haemoptysis.with two episodes of haemoptysis.

• He was detected to have a right hilar He was detected to have a right hilar opacity on X-ray chest for which he opacity on X-ray chest for which he was being treated with Anti-T.B. for was being treated with Anti-T.B. for four months without significant four months without significant response. response.

• Was referred for a CT scan. Was referred for a CT scan.

H.R.C.T.H.R.C.T.

Contrast enhanced CTContrast enhanced CT

Coronal Recon. HRCTCoronal Recon. HRCT

Virtual BronchoscopyVirtual Bronchoscopy

CASE 7CASE 7

• DIAGNOSIS ????DIAGNOSIS ????

• No d/d allowed.No d/d allowed.

CASE 8CASE 8

• A 56 yr./female had h/o chronic A 56 yr./female had h/o chronic cough and breathlessness for four cough and breathlessness for four months.months.

• She is in to making potato wafers She is in to making potato wafers commercially at home involving commercially at home involving boiling of large qty. of potatoes in boiling of large qty. of potatoes in closed room. closed room.

X-ray chestX-ray chest

End insp. HRCTEnd insp. HRCT

End-exp. HRCTEnd-exp. HRCT

Coronal insp and exp. Coronal insp and exp. hrcthrct

Case 8Case 8

• DIAGNOSIS ????DIAGNOSIS ????

CASE 9CASE 9

• Incidental abnormality noted on a Incidental abnormality noted on a non-contrast CT of chestnon-contrast CT of chest

Non-contrast CT chestNon-contrast CT chest

CT scan (contd.)CT scan (contd.)

CT scan (contd.)CT scan (contd.)

Case 9Case 9

• DIAGNOSIS ????DIAGNOSIS ????

CASE 10CASE 10

• A 16 yr./female presented with A 16 yr./female presented with inspiratory stridor.inspiratory stridor.

• Bronchoscopy revealed extrinsic Bronchoscopy revealed extrinsic impression on posterior tracheal wall. impression on posterior tracheal wall.

• CT advised to r/o posterior CT advised to r/o posterior mediastinal nodes. mediastinal nodes.

X-ray chestX-ray chest

CT scan with oral and I.V. CT scan with oral and I.V. contrastcontrast

Coronal Recons.Coronal Recons.

CASE 10CASE 10

• DIAGNOSIS ????DIAGNOSIS ????