chap1_1
DESCRIPTION
chap1_1TRANSCRIPT
CD QUIZ 1: Twelve More Great Cases
Unknowns
Introduction: Here are 12 unknown cases. They are presented in the same manner as quizzes in the text, with questions to guide you. When plain films and CT scans are presented, make the plain film observations before turning to the CT scans. Use a piece of paper to write your answers before clicking on
The next quiz, Quiz 2, will give you only a brief history.
In some cases, additional images will be shown when you click on:
Exit
Next
2) The [left lung is too radiodense/right lung is too radiolucent].
Previous
1
1) The lung density is [symmetrical/asymmetrical].
This asymmetry could be due to:
• lung consolidation
• diffuse atelectasis
• layered pleural effusion
• all of the above
4) The best explanation for the dense left lung is left lung atelectasis due to right main bronchus intubation .
Click for an additional image (B).
This is an AP portable x-ray from the ICU.
Image A
3) The nasogastric tube tip is in the stomach . The endotracheal tube is in the right main bronchus .
Exit
Next
A.
2
Figure A
1) Figure A is a Scout view from a CT scan. You know or can tell that the patient is [supine/erect/decubitus].
Figure B Figure C
This is a 56-year-old woman with hemoptysis.
3) Figure B is a chest CT at [lung/bone] windows. The CT confirms the mass and also an air fluid level within the cavity. The air fluid level was not seen on the Scout view. Why not? The beam is not parallel to the fluid level on the Scout view .
4) On the CT, the interface with the lung is [well defined/ill defined]. This suggests we are dealing with a [cavitary pneumonia/an intrapleural collection/cavitation within a tumor]. 5) Figure C was taken 10 minutes later, at mediastinal windows. What do you think is happening to the patient at this moment? percutaneous needle biopsy (histology = lung cancer) .
Exit
Previous Next
A. B. C.
2) The principal finding is a mass in the [right upper lobe/right middle lobe/right lower lobe]. Is there anything unusual about this mass? central cavity
3
Image A
1) The high density abnormalities on the right are [in the axilla exclusively/in the lung exclusively/probably in both]. These metallic densities are due to Buckshot .
Image B
This is a routine chest x-ray (A, B) on a middle-aged man. There are two abnormalities, one at each end of the density scale.
Click here for additional images (C & D).
Exit
Previous Next
A. B.
2) Don’t let satisfaction of search stop you there. There is another significant abnormality, of low density, on this radiograph. It isa hiatal hernia behind the heart .
4
Image A
This is a 70-year-old woman with shortness of breath.
1) Image A is [axial/sagittal/coronal].
2) Image B is sagittal . They are displayed at [lung/mediastinal/bone] windows.
3) Density marked with the * is diaphragm (liver) .
4) The pattern is one of [interstitial thickening/alveolar consolidation/bronchiectasis].
5) The interstitium is [sharp/indistinct] and is also [distorted/not distorted].
6) This process appears to be [ acute / chronic ].
Image B
Exit
Previous Next
A. B.
5
Image A
This is an older man with chronic nonproductive cough. He comes to the emergency room because of increasing shortness of breath over the past six hours. This is an AP Supine image.
1) The 5th right posterior rib is marked. The diaphragm is at approximately the level of the posterior [9th/10th/11th/12th] rib. The diaphragm is normally at the level of the [8-9th/9-10th/10-11th/11-12th] posterior rib.
2) The markings in the left upper lobe are [increased/normal/decreased]. Answers 1&2 should lead you to the diagnosis of emphysema, COPD .
Click here for an additional image (B).
3) What explains the acute shortness of breath? right pneumothorax How did you make that diagnosis? see pleural line, air in the pleural space (crowded markings)
Exit
Previous Next
A.
4) The large mass seen on the PA film is also seen on the lateral film (Image B) in the retrosternal space .
6 This is a 26-year-old man with pressure in his chest.
2) The left hemidiaphragm is elevated .
3) On Image B, there is blunting of the left costophrenic angle, indicating a pleural effusion . The fissures are also thick, probably on the left.
Image A Image B
Click here for additional images (C & D).
(Continued…)
Exit
Previous Next
A. B.
1) Image A shows that the right paratracheal stripe is (visible/not visible). The aortic knob is [large/small/not visible]. The right lung [contacts/does not contact] the right tracheal wall.
6) The most likely cause of a mass in the anterior and middle mediastinum in a 26 year old man is [thymoma/thyroid enlargement/thoracic aortic aneurysm/terrible lymphoma].
6 This is a 26-year-old man with pressure in his chest. (Continued…)
Image A Image B
Exit
Previous Next
A. B.
5) This mass must be in the (choose one or more):a. anterior mediastinum Why? in retrosternal space b. middle mediastinum Why? adjacent to trachea and aorta affects phrenic nerve (elevated diaphragm) c. posterior mediastinum Why? not posterior mediastinum
Click here for additional images (C & D).
7
Image A
This is an 18-year-old with chronic cough.
3) On Image C, the tubular structures in the upper lobe represent bronchiectasi .
4) This axial CT (Image D) shows that many of the bronchi are [normal/dilated/narrowed]. The walls of the bronchi are [normal/thicker/thinner] than usual.
5) The best diagnosis for this young lady, who has been sick since childhood, is cystic fibrosis .
Image B Image C
Exit
Previous Next
A. B. C.
Click here for an additional image D.
2) In most patients with emphysema, the markings in the upper lobes are [normal/increased/decreased]. In this patient, the markings are [normal/increased/decreased].
1) On Images A and B, the lung volumes are large . What criteria did you use?The diaphragms are low. The retrosternal space is increased. The AP diameter is increased .
8
Image A
This is a middle-aged woman with a cough and fever for three days.
1) On Images A & B, there is a 3-cm area of consolidation in the left lower lobe.
3) The history and X-ray findings support a diagnosis of pneumonia .
Image B
Click here for additional images (C & D).
Exit
Previous Next
A. B.
2) There is an additional finding on the lateral radiograph. There is blunting of one costophrenic angle. The fluid is against the [small ribs (A)/big ribs (B)]. The small ribs are on the [ left/right ]. Therefore, this is a [left/right] effusion.
9
Image 1
Scroll through the images given below, then attempt the questions.
Image 3Image 2 Image 4
Image 5 Image 7Image 6 Image 8(Continued…)
This is a middle-aged man with shortness of breath. Here is a series of CT images that you will be asked to scroll through.
Exit
Previous Next
9
Scroll through the images given below, then attempt the questions.
Image 13 Image 15Image 14 Image 16(Continued…)
This is a middle-aged man with shortness of breath. Here is a series of CT images that you will be asked to scroll through.(Continued…)
Exit
Previous Next
Image 9 Image 11Image 10 Image 12
9
Scroll through the images given below, then attempt the questions.
Image 21 Image 23Image 22 Image 24(Continued…)
This is a middle-aged man with shortness of breath. Here is a series of CT images that you will be asked to scroll through.(Continued…)
Exit
Previous Next
Image 17 Image 19Image 18 Image 20
9
Scroll through the images given below, then attempt the questions.
Image 29 Image 31Image 30 Image 32(Continued…)
This is a middle-aged man with shortness of breath. Here is a series of CT images that you will be asked to scroll through.(Continued…)
Exit
Previous Next
Image 25 Image 27Image 26 Image 28
9
Scroll through the images given below, then attempt the questions.
Image 37 Image 39Image 38 Image 40(Continued…)
This is a middle-aged man with shortness of breath. Here is a series of CT images that you will be asked to scroll through.(Continued…)
Exit
Previous Next
Image 33 Image 35Image 34 Image 36
9
Scroll through the images given below, then attempt the questions.
Image 45 Image 47Image 46 Image 48(Continued…)
This is a middle-aged man with shortness of breath. Here is a series of CT images that you will be asked to scroll through.(Continued…)
Exit
Previous Next
Image 41 Image 43Image 42 Image 44
9
Scroll through the images given below, then attempt the questions.
Image 53 Image 55Image 54 Image 56(Continued…)
This is a middle-aged man with shortness of breath. Here is a series of CT images that you will be asked to scroll through.(Continued…)
Exit
Previous Next
Image 49 Image 51Image 50 Image 52
9
Scroll through the images given below, then attempt the questions.
Image 61 Image 63Image 62(Continued…)
This is a middle-aged man with shortness of breath. Here is a series of CT images that you will be asked to scroll through.(Continued…)
Image 64
Exit
Previous Next
Image 57 Image 59Image 58 Image 60
9
1) This is displayed in [bone/mediastinal/lung] windows.
2) This was done [with/without] intravenous contrast.
Click here for additional images Y & Z, after you answer all the questions.
3) Mediastinal windows are used to evaluate for (Select one or more):
a. bone metastasis d. vascular lesionsb. for bronchiectasis e. cardiac abnormalities c. lymphadenopathy f . cavitation
This is a middle-aged man with shortness of breath. Here is a series of CT images that you will be asked to scroll through.(Continued…)
4) Scroll through the images and determine why the patient was short of breath large bilateral pulmonary emboli, most severe in the left main pulmonary artery and in the artery to the right middle and right lower lobe (truncus inferior)
Exit
Previous Next
3) The lesion sits [anterior/posterior] to the major fissure. Therefore, it is in the left upper lobe.
10 This is a 58-year-old male with a cough and weight loss. Let’s do something different! Let’s start off with the CTs, make the observations, and mentally reconstruct the chest x-ray.
2) Medial to the lesion is another soft-tissue density, which probably represents [a mediastinal mass/a big pulmonary artery/hilar nodes].
Image A Image B Image C
(Continued…)
Exit
Previous Next
A. B. C.
1) A and B are cross-sectional images at the level of the [aortic arch/carina/left ventricle]. The major abnormality is a [nodule/mass].
5) What is your most likely diagnosis? Not surprisingly, this is a left upper lobe cancer with hilar adenopathy in a smoker . Now visualize the chest PA and lateral in your mind or sketch it on your paper.
10 This is a 58-year-old male with a cough and weight loss. Let’s do something different! Let’s start off with the CTs, make the observations, and mentally reconstruct the chest x-ray. (Continued…)
Click here to see the real thing (D & E).
Exit
Previous Next
Image A Image B Image C
A. B. C.
4) Image C is a coned-down view of the right upper lobe. It shows bulla . Therefore, the patient has what chronic disease? emphysema
11 This is a young man with mild shortness of breath for several months.
2) In Image B, the lungs show [cysts/nodules/fibrosis and distortion].
3) The best diagnosis would be [sarcoidosis/lymphoma/miliary TB].
Image A Image B
Exit
Previous Next
A. B.
1) In Image A, the hilar structures are [large/normal/small]. The most frequent cause of bilateral large hila is [big pulmonary arteries/adenopathy/idiopathic].
12
1) Images A and B show an obvious mass on the right. It appears to be in the [RUL/RML/RLL/can’t tell].
2) How does Image C help define the origin? There is an expansile lesion of rib .
3) The best diagnosis is [multiple myeloma/lung cancer/pneumonia].
Image A Image B
This is an older man with right chest pain.
Exit
Previous
A. B.
Click here for an additional image C.