Regarding pulmonary lymphangioleiomyomatosis:

a. Chylous pleural effusion is a recognized feature.

b. It characteristically affects the upper twothirds of the lungs and spares the costophrenic angles.
c. Multiple pulmonary cysts are seen on CT.
d. The changes on CT may be indistinguishable fromtuberous sclerosis.
e. If pneumothorax is present, another diagnosis should be considered.
Answer:
a. True. The classic chest radiograph manifestations include interstitial pulmonary disease,
chylous pleural effusions and recurrent pneumothoraces.
b. False. Pulmonary lymphangioleiomyomatosis involves the lungs diffusely. Langerhans cell
histiocytosis characteristically involves the upper two-thirds of the lungs and spares the
costophrenic angles.
c. True. Evaluation of the pulmonary cysts in lymphangioleiomyomatosis is best done with CT.
d. True. Despite the suggestive appearance of lymphangioleiomyomatosis on CT, the differential
diagnosis includes tuberous sclerosis, Langerhans cell histiocytosis and emphysema.
Identical clinical, radiological and histological pulmonary changes may be seen in 1% of
patients with systemic sclerosis.
e. False. See a) above.
Avila NA, Chen CC, Chu SC, Wu M, J ones EC, Neymann RD, et al.
Pulmoanry lymphangioleiomyomatosis: correlation of ventilation-perfusion scintigraphy, chest radiography, and CT with
pulmonary function tests.
Radiology 2000;214:441-6.

Concerning pulmonary arteriovenous malformation (PAVM):
a. OslerWeberRendu disease is a recognized association.
b. Cerebrovascular accident is a recognized presentation.
c. A pulmonary bruit may be audible on auscultation over a large peripheral PAVM.
d. Tc99m-labelled macroaggregates can be used to confirm the presence of a right to left shunt.
e. Embolisation coils should be placed in the feeding artery proximally to ensure occlusion.
Answer:
a. True. Patients with Osler-Weber-Rendu disease (hereditary haemorrhagic telangiectasia) form the majority (79-90%) of
the pulmonary arteriovenous malformation population and often have multiple lesions.
b. True. Due to right-to-left shunting.
c. True. This bruit may be intensified as pulmonary blood flow increases during forced
inspiration and the Mueller manoeuvre.
d. True. Tc99m-labelled microaggregates can be used to confirm the presence of right-to-left shunting and to determine
the size of the shunt.
e. False. Coils should be placed as distally as possible so as not to occlude proximal vessels supplying normal lung.
Coley SC, J ackson J E. Pulmonary venous malformations.
Clin Radiol 1998;53:396-404.

Regarding the vascular manifestations of Behcets disease:
a. Only arteries are affected.
b. Vascular involvement is more frequent in men than in women.
c. The popliteal artery is the most common site for pseudoaneurysmformation.
d. Occlusions and stenoses are more common in distal run-off arteries than mediumsized arteries.
e. Angiography is the investigation of choice.
Answer:
a. False. Arteries or veins can be affected.
b. True. The male:female ratio is 4-5:1.
c. False. The aorta is the most commonly affected site, followed by pulmonary, femoral, subclavian and popliteal arteries.
d. True. Occlusions and stenoses are more frequent in smaller arteries.
e. False. Thrombosis and pseudoaneurysm formation at the puncture site are more common
in patients with Behcets disease, therefore CT and MR are the investigations of choice.
Ko G-Y, Byun J Y, Choi BG, Cho SH.
The vascular manifestations of Behcets disease: angiographic and CT findings.
Br J Radiol 2000;73:1270-4.

Regarding interstitial pneumonitis:
a. Patients with usual interstitial pneumonitis respond well to corticosteroids.
b. Honeycombing on high resolution CT is the characteristic feature in non-specific interstitial
pneumonitis.
c. Desquamative interstitial pneumonitis (DIP) typically affects young women.
d. DIP is not associated with smoking.
e. Acute interstitial pneumonitis has a good prognosis.
Answer:
a. False. Usual interstitial pneumonitis (UIP) has a poor prognosis and poor response to steroids.
b. False. The dominant pattern of non-specific interstitial pneumonitis on HRCT is ground glass. Honeycombing is more
commonly seen in UIP.
c. False. Desquamative interstitial pneumonitis (DIP) is twice as common in men, with an average age at presentation of
42 years.
d. False. Over 90% of patients with DIP are heavy smokers.
e. False. Acute interstitial pneumonitis has a poor prognosis. Average survival from onset of symptoms is approximately 2
months.
Reynolds J H, Hansell DM. The interstitial pneumonias: understanding the acronyms.
Clin Radiol 2000;55:249-60.

Concerning Takayasus arteritis:
a. More men are affected than women.
b. The affected vessel can become stenotic.
c. Aneurysmformation is more likely in an aorta with little calcification than in a heavily calcified aorta.
d. Aortic wall thickening is associated with increased chance of aneurysmal rupture.
e. Aortic aneurysms do not increase in size.
Answer:
a. False. In the age range 15-41 years, the male: female ratio is 1:8. It is most common in Asia.
b. True. The affected vessel can become stenotic, occluded or aneurysmal.
c. True. An aorta with little calcification has a greater possibility of aneurysm formation in Takayasus arteritis.
d. True. Aortic aneurysms with aortic wall thickening should be closely followed up.
e. False. It can be a late complication.
Ref.: Sueyoshi E, Sakamoto I, Hayashi K. Aortic aneurysms in patients with Takayasus arteritis: CT evaluation. AJ R
2000;175:1727-32.

Concerning thoracic manifestation of Wegener granulomatosis:
a. Necrotizing vasculitis of small arteries and veins is the pathological hallmark.
b. The lung disease shows multiple irregular nodules in 515% of cases.
c. Typically, the nodules have a peribronchialvascular distribution.
d. Cavitation of nodules occurs in 4060% of cases.
e. CT may show nodular thickening of the trachea.
Answer:
a. True. Wegeners granulomatosis is a systematic autoimmune disease characterized by granulomatous vasculitis of the
upper and lower respiratory tract, glomerulonephritis and small vessel vasculitis.
b. False. Multiple irregular lung nodules are the most common radiographic manifestation. The solitary nodule occurs in
25% of cases. There is no zonal predilection.
c. True. Peripheral, wedge shaped areas of consolidation may also be seen.
d. True. Nodular cavitation with thick irregular and thick walls, occurs in 50% of cases.
e. True. Nodular and smooth thickening of the trachea or bronchial walls occurs secondary to
mucosal or submucosal granulomatous thickening.
Reference: Mayberry J P, Primack SL, Muller NL. Thoracic manifestations of systematic autoimmune diseases:
radiographic and high resolution CT findings. Radiographics 2000;20:162335.

Concerning the thoracic manifestation of rheumatoid arthritis:
a. Pulmonary fibrosis occurs in 515% of cases.
b. Limited upper lobe fibrosis and cavitation are recognized findings.
c. High resolution CT may show a mosaic pattern of attenuation and perfusion.
d. Lung nodules are pathologically identical to subcutaneous nodules.
e. There is an increased incidence of lung carcinoma in patients with pulmonary fibrosis.
Answer:
a. True. Pulmonary fibrosis occurs in 8% of cases, predominantly affecting the lung periphery and lower lung zones.
b. True. Rarely, the fibrosis is limited to the upper lobes, mimicking that of TB.
c. True. Mosaic pattern occurs secondary to obliterative bronchiolitis.
d. True. The lung nodules are usually multiple, well circumscribed and may cavitate.
e. True. Like any other cause of pulmonary fibrosis, there is increased incidence of lung carcinoma.
Reference: Mayberry J P, Primack SL, Muller NL.
Thoracic manifestations of systematic autoimmune diseases: radiographic and high resolution CT findings.
Radiographics 2000;20:162335.

Regarding asbestos-related benign pleural disease:
a. Pleural plaques arise fromthe visceral pleura.
b. Folded lung is diagnostic of asbestos exposure.
c. Pleural plaques generally spare the costophrenic angles and apices.
d. Typically, there is associated obstructive ventilatory defect in patients with diffuse pleural thickening.
e. Presence of pleural nodularity, pleural rind and thickening of more than 1 cmare features of malignancy.
Answer:
a. False. Pleural plaques are almost invariably arising from the parietal pleura.
b. False. Folded lung can also be seen in any cause of organizing pleural exudates, such as tuberculosis, histoplasmosis,
Dresslers syndrome and haemothorax.
c. True. Pleaural plaques tend to lie adjacent to rigid structures such as ribs, vertebral column and the tendinous portion
of the diaphragm.
d. False. Typically, there is associated restricitive ventilatory defect.
e. True. Presence of pleural rind, pleural nodularity, pleural thickening of more than 1 cm and mediastinal pleural
involvement are features suggestive of malignancy.
Reference: Peacock C, Copley SJ , Hansell DM. Asbestos-related benign pleural disease. Clin Radiol 2000;55:42232.

Regarding lupus eythromatosus:
a. It is characterized at histologic examination by deposition of autoantibodies and immune complexes.
b. Pleural disease develops in 4050% of cases.
c. Haemorrhage is a recognized cause of lung parenchymal opacification.
d. The chest radiograph in acute lupus pneumonitis shows bilateral areas of consolidation.
e. The disease predominantly affects males.
Answer:
a. True. The histological hallmark of systemic lupus erythromatosus is deposition of autoantibodies and autoimmune
complexes that damage tissues and cells.
b. True. The most common radiological manifestation of pleural disease is unilateral or bilateral effusion with or without
pericardial effusion.
c. True. Parenchymal opacification may be caused by pneumonia (most commonly), haemorrhage or pulmonary oedema.
d. True. Acute lupus pneumonitis is a diagnosis of exclusion. Pneumonia and pulmonary haemorrhage show similar
appearances.
e. False. It predominantly affects women (female:male 10:1) aged 2050 years.
Reference: Mayberry J P, Primack SL, Muller NL.
Thoracic manifestations of systematic autoimmune diseases: radiographics and high-resolution CT findings.
Radiographics 2000;20:162335.

Regarding aortic prosthetic graft infection:
a. Perigraft air is pathognomonic of graft infection in the first post-operative week.
b. A 5 mmsoft tissue attenuation between the graft and the aneurysm is a normal finding in the early post-operative period.
c. Pseudoaneurysms occur in 2030% of graft infections.
d. Tc99mhexametazine is an excellent complementary test in the diagnosis of graft infection.
e. Aortic stump blowout frequently manifests as a confined aneurysm.
Answer:
a. False. Perigraft air is rare beyond the first week following surgery.
b. True. It is a normal finding for up to 3 months post-operatively.
c. True. Pseudoaneurysms occur in 25% of graft infections, but the majority of patients with pseudoaneurysms have no
graft infection.
d. True. False positive results can, however, occur due to cross labelling of platelets or adjacent soft tissue infection.
e. True. It is believed that stump blowout occurs secondary to residual contamination of the graft bed or low grade
infection in the arterial wall.
Reference: Orton DF, LeVeen RF, Saigh J A, Culp WC, Lynch TJ , Goertzen TC, et al.
Aortic prosthetic graft: radiological manifestations and implications for management. Radiographics 2000;20:977-94.

Concerning pulmonary drug toxicity:
a. Non-specific interstitial pneumonia (NSIP) is the most common manifestation of amiodarone toxicity.
b. HRCT, in early diffuse alveolar damage (DAD), shows scattered or diffuse areas of ground-glass opacification.
c. Cyclophosphamide is a recognized cause of pulmonary haemorrhage.
d. Methotrexate lung toxicity occurs in 1020% of cases.
e. Bronchiolitis obliterans organizing pneumonia (BOOP) is the most common manifestation of gold-induced lung disease
Answer:
a. True. BOOP is a less common type and typically occurs in association with NSIP
b. True. The ground-glass opacification reflects the pathological changes that occur in the acute (exudative) phase of
diffuse alveolar damage. This phase is characterized by alveolar and interstitial oedema and hyaline membrane disease.
c. True. Other drugs causing pulmonary haemorrhage include anticoagulants, amphotericin B, mitoycin and penicillamine.
d. True. The incidence of lung toxicity in methotrexate lung toxicity is 10%.
(e) False. DAD and NSIP are the most common pathologic manifestations of gold-induced lung injury.
Reference: Rossi SE, Erasmus J J , McAdams HP, Sporn TA, Goodman PC.
Pulmonary drug toxicity: radiologic and pathologic manifestations. Radiographics 2000;20:1245-59.

Concerning interstitial pneumonia:
a. Usual interstitial pneumonia (UIP) is the most common type of idiopathic interstitial pneumonia.
b. On HRCT, subpleural reticular pattern and honeycombing, irregular pleural surface, and traction bronchiectasis are among the
diagnostic features of usual interstitial pneumonia.
c. The most common HRCT abnormality in non-specific interstitial pneumonia is patchy ground-glass opacity, with an apical
predominance.
d. 8090% of patients with desquamative interstitial pneumonia are heavy smokers.
e. The chest radiograph in acute interstitial pneumonia invariably shows bilateral pulmonary consolidation.
Answer:
a. True. It was found in 62% of lung biopsies in one series.
b. True. On HRCT, subpleural reticular pattern and honeycombing with numerous thick walled cyst like spaces, irregular
pleural surface and traction bronciectasis are diagnostic features of UIP to the extent that biopsy is not indicated.
c. False. The most common HRCT feature in non-specific interstitial pneumonia is patchy ground-glass opacity with a
basal predominance and subpleural distribution.
d. True. 90% of patients with DIP are heavy smokers and they usually respond to steroid therapy.
e. True. On CT there are areas of ground-glass opacity and air space consolidation with or without traction
bronchiectasis.
Reference: Reynolds J H, Hansell DM. The interstitial pneumonia: understanding the acronyms. Clin Radiol 2000;55:249-
60.

Regarding the thoracic manifestations of HIV disease:
a. Bacterial pneumonia is the most common chest infection in patients who are HIV positive.
b. Kaposis sarcoma is an unlikely diagnosis with a CD4 count greater than 200 cells/mm3.
c. Cavitation of infectious origin is more common at lower CD4 counts.
d. The most frequent imaging findings of thoracic AIDS-related lymphoma are multiple pleural or intrapulmonary masses.
e. The incidence of non-specific interstitial pneumonitis is 2040%.
Answer:
a. True. The organisms encountered mirror those of community acquired pneumonia.
b. True. Kaposis sarcoma is likely to occur when the CD4 count is 200 cells/mm3. Opportunistic chest infections do not
generally occur prior to a fall in the CD4 count to less than 200 cells/mm3.
c. False. It is less common at low CD4 counts.
d. True. They are usually peripheral and may cavitate.
e. True. Non-specific interstitial pneumonia is more common in Africans and in IV drug abusers than in homosexual men.
Reference: Padley SPG, King LJ . Computed tomography of the thorax in HIV disease. Eur Radiol 1999;9:1556-69.

The following are causes of an enlarged right atrium:
a. Interstitial lung disease
b. VSD
c. Ebsteins anomaly
d. ASD
e. PDA
Answer:
-T
-F
-T Low lying abnormal TV causing atrializationof the proximal RV
-T
-F

The following are true of an ASD:
a. Commoner in females
b. The commonest type is an OstiumPrimum
c. In OstiumSecundum, there is a 30% association with MVP
d. Lutembacher Syndrome =ASD and AR
e. Is essential for survival with tricuspid atresia
Answer:
-T
-F Ostium Secundum
-T
-F ASD and MS (congen or acquired)
-T

The following are true of a PDA:
a. It is derived fromthe fourth aortic arch
b. Is commoner in males
c. Normal anatomic closure takes place in the majority by two weeks
d. Is beneficial with an isolated VSD
e. May cause an enlarged right ventricle
Answer:
-F Sixth aortic arch
-F Females
-F Normal functional closure by 48 hrs. Anatomic closure; 35% by 2/52, 90% by 2/12 and 99% by 1 year.
-F Bad with L to R shunts as shunt volume increases. Beneficial with Fallots, Eisenmenger and interrupted aortic arch.
-F Right chambers unaffected

A bulge in the left heart border is seen with:
a. Ebsteins anomaly
b. TAPVR
c. Mitral stenosis
d. Pericardial Defect
Answer:
-F
-F
-T
-T

Pericardial defects:
a. Are commoner in females
b. In 10% there is partial absence of the pericardium
c. Left foraminal defects and complete left sided absence make up the majority of defects
d. Are associated with bronchogenic cysts
e. Foraminal defects require surgery
Answer:
-F M:F 3:1
-F 90% partial and 10% complete
-T Together =70%
-T Also CHD, MS, Diaphragmatic hernia and sequestration. NOT with pericardial cysts/effusions
-T Because of risk of herniation

Pericardial cysts:
a. May be secondary to pericarditis
b. Are commoner in males
c. 50% are asymptomatic
d. The majority are left sided
e. The majority are in the costo-phrenic angles
Answer:
-T
-T M:F 3:2
-T
-F R:L 3:1
-T 75%

The following are causes of an enlarged left atrium:
a. PDA
b. VSD
c. ASD
d. Pulmonary Arterial Hypertension
Answer:
-T
-T
-F
-F