SBA Chest

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Respiratory System Radiology

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"This 41-year-old woman developed acute left-sided chest pain. She has had gradually increasing shortness of breath and a dry cough over the last 8 months, and has a 25-pack-year history of cigarette smoking. Her posteroanterior chest radiograph is presented. Which one of the following is the MOST likely diagnosis?

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"You are shown two images from a high-resolution CT of the chest of a 40-year-old female smoker with a 1-year history of increasing shortness of breath. What is the MOST LIKELY diagnosis?

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"You are shown CT images of a 51-year-old man with dyspnea and history of lung carcinoma who is status-post erlotinib and radiation therapy. What is the MOST likely diagnosis?

      

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"You are shown two images of a 41-year-old man presenting with cough. Staging of this disease is based primarily on which of the following?

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"You are shown axial CT images of a 65-year-old woman with dyspnea. What is the MOST LIKELY explanation for the findings demonstrated on CT?

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"You are shown two axial images from a CT scan of the chest of a 48-year-old woman with an abnormal chest radiograph. Which one of the following is the MOST LIKELY diagnosis?

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"You are shown two CT images of a 30-year-old woman with a history of shortness of breath. Which one of the following is the MOST likely diagnosis?

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You are shown two axial images from a CT scan of the chest of an 80-year old-man. Which of the following drugs is MOST LIKELY responsible for the radiographic finding?

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"You are shown CT images of a 68-year-old woman with history of acute mitral regurgitation. What is the MOST likely cause of the abnormality demonstrated on the images?

  

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"You are shown PA and lateral chest radiographs from a 53-year-old woman with mild dyspnea. Which one of the following is the MOST likely diagnosis?

  

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"You are shown a chest radiograph of a 47-year-old woman with worsening shortness of breath over the past 3 months. What is the MOST LIKELY diagnosis?

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"What is the MOST LIKELY diagnosis of a 60-year-old man who presented with chest heaviness and dyspnea after being diagnosed with lung cancer three months earlier?

    

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"A 30-year-old woman presents with cough and dyspnea. Which of the following laboratory findings is MOST LIKELY to be abnormal?

      

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Which of the Fleischner Society recommendations would apply to a 50-year-old woman with a history of melanoma, who has been newly diagnosed with an indeterminate 5 mm nodule?

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"You are shown a chest radiograph and an axial image from a CT scan of the chest of a 37-year-old man whose bronchoscopy revealed lipo-proteinaceous fluid. What is the MOST appropriate treatment for the man's diagnosis?

  

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According to the Fleischner Society guidelines for management of small pulmonary nodules detected on CT scan of the chest, when should a follow-up CT scan be performed for a 4-mm nodule in a low-risk patient?

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"You are shown a PA chest radiograph and two axial images from a CT scan of the chest of a 22-year-old man. What is the MOST LIKELY diagnosis?

    

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"This 74-year-old male presented to his primary physician for a routine chest radiograph. His subsequent non-contrast CT is also shown. Which one of the following is the MOST likely diagnosis?



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"This 40-year-old smoker was admitted for dyspnea. Shown is the initial chest radiograph. Also shown is the subsequent non-contrast chest CT after chest tube placement. Images are non-contiguous. Which one of the following is the MOST likely diagnosis?

  A. Sarcoidosis
B. Desquamative interstitial pneumonia (DIP)
C. Usual interstitial pneumonia (UIP)
D. Langerhans cell histiocytosis (LCH)
E. Emphysema

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"You are shown PA and lateral chest radiographs of a previously healthy 58-year-old man and two images from a contrast-enhanced chest CT (mediastinal window). Which one of the following is the MOST likely diagnosis?

      

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"This 74-year-old patient complains of dyspnea. You are shown frontal and lateral chest radiographs. Which one of the following is the MOST likely diagnosis?

  

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"You are shown PA and Lateral chest radiographs from a 33-year-old HIV positive woman with cough and fever. Which one of the following is the MOST likely pathogen?

  

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"A. Fibrosing mediastinitis is a rare disorder characterized by chronic inflammation and fibrosis of mediastinal soft tissues. There are many causes of fibrosing mediastinitis. The most frequently implicated process is infection, of which Histoplasma capsulatum is the most common cause. Complications of fibrosis within the mediastinum lead to encasement and compression of mediastinal structures. Those that are particularly involved include superior vena cava, trachea and bronchi, and pulmonary artery and veins. Aorta and great vessel involvement is extremely rare.

Axial CECT of the same patient demonstrates mediastinal widening and infiltrative soft tissue within the mediastinal fat . A metallic stent  has been placed within the occluded SVC to treat SVC obstruction secondary to mediastinal fibrosis, which can obstruct vessels and airways.

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"You are shown an axial image from a noncontrast CT and an MRI of the chest, without and with contrast, in an asymptomatic 45-year-old man. What is the MOST LIKELY diagnosis?

    

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"This 65-year-old male developed a change in his baseline cough and new streaks of blood in his sputum. His posteroanterior chest radiograph and lateral chest radiograph are presented. Which one of the following is the MOST likely diagnosis?

  

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"This 58-year-old male had increasing shortness of breath over 6 months. His posteroanterior chest radiograph and a single image from a high-resolution CT examination are presented. Which one of the following is the MOST likely diagnosis?

  

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"This 42-year-old woman presented with fever and night sweats. Her posteroanterior and lateral chest radiographs are presented as well as an image from her post-contrast chest CT. Which one of the following is the MOST likely diagnosis?

    

Findings: The chest CT examination shows diffuse ground glass with some septal lines and a spiculated fat-attenuation mass in the left lower lobe.

A. Pulmonary alveolar proteinosis refers to the deposition of lipo proteinaceous material in the alveolar spaces. For this reason, some refer to it as endogenous lipoid pneumonia. Chest radiography shows bilateral diffuse alveolar opacities, often with a superimposed fine reticular pattern. CT scanning demonstrates diffuse ground glass opacity with smooth septal lines (crazy-paving appearance). Although the ground glass appearance and the septal lines are consistent with alveolar proteinosis, the diagnosis is not the best because it would not explain the fat-attenuation in the left base. Macroscopic fat, however, is never seen with this entity.
B. Lipoid pneumonia results from aspiration of vegetable, animal, or mineral oil, and usually occurs in debilitated patients with swallowing abnormalities or patients taking mineral oil for treatment of constipation. Most patients are relatively asymptomatic. Plain chest radiographs show areas of lung opacification or mass lesions that remain stable or slowly increase over a period of months. On CT, these areas have a low attenuation because of their lipid contents.
C. The most common radiographic findings of pulmonary edema include interstitial and alveolar edema, pulmonary vascular redistribution and pleural effusions. The edema is usually gravity dependent and therefore more severe at the lung bases. CT findings include ground-glass opacity and septal lines. In the test case, the ground glass opacity and septal lines are not gravity dependent, and therefore not consistent with pulmonary edema. Moreover, this diagnosis would not explain the fat-attenuation.
D. Usual interstitial pneumonia (UIP) is a type of chronic interstitial pneumonia. Radiographic findings include ground-glass opacities and reticular interstitial opacities, including thickened septal lines and honeycombing. The abnormality has a predilection for the subpleural aspects of the lung bases. Symmetric bilateral ground glass opacity with superimposed septal lines forming a crazy paving pattern is not a feature of UIP. A fat attenuation mass also is not a characteristic of UIP. It should be noted that spiculated lesions may be seen with UIP and are concerning given the increased incidence of bronchogenic cancer with this condition.
E. Wegener’s granulomatosis is characterized by necrotizing granulomatous vasculitis of the respiratory tract. The disease involves both arteries and veins. Upper airway involvement manifesting as sinusitis, rhinitis, and otitis is common. The typical imaging features are nodules, either single or multiple, which may cavitate, and areas of lung opacity, which may have a ground glass appearance, representing hemorrhage. The fat attenuation within the mass lesion of this patient is not characteristic of Wegener’s Granulomatosis and makes this diagnosis very unlikely.

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"This 74-year-old woman had a left lower lobe mass seen on chest radiograph. Three images from her non-contrast chest CT are presented; two at lung window-settings and one at soft-tissue window setting. Which one of the following is the MOST likely diagnosis?

    

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"In this 68-year-old woman with shortness of breath, a posteroanterior and lateral chest radiograph are submitted for review. Three images from a post-contrast enhanced CT are also presented. Which one of the following is the MOST likely diagnosis?

    

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"This 39-year-old man had an incidental finding on a chest radiograph as part of being evaluated as a bone marrow donor. CT images at lung window and soft tissue window settings through that abnormality are presented. Which one of the following is the MOST likely diagnosis?

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"This 51-year-old woman presented with 4 month history of a non-productive dry cough. Posteroanterior chest radiograph and two CT images are presented. Which one of the following is the MOST likely diagnosis?

    

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"This 24-year-old female presented to the emergency department complaining of fever and dyspnea. You are shown a posteroanterior chest radiograph and two non-consecutive images from the patient’s post-intravenous contrast chest CT. Which one of the following is the MOST likely diagnosis?

    

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"You are shown a chest CT of a 65-year-old nonsmoker performed for a chest radiograph abnormality. Assuming this area of ground glass attenuation is a malignancy, which one of the following is the MOST likely diagnosis?

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