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1-1: Please answer the following with TRUE or FALSE regarding Swyer-James syndrome.
a. T or F The mediastinum deviates away from the effected lung on expiration.
b. T or F The affected side is larger than the contralateral normal lung.
c. T or F Is an example of bronchiolitis obliterans.
d. T or F The segmental bronchi terminate abruptly.
e. T or F Pathologic specimens demonstrate anthracotic changes..


Click here for an overview of Swyer-James syndrome.

1-2: Which choice is NOT seen (or is NOT typically more easily seen) on a supine CXR in a patient with a small pneumothorax.
A Deep sulcus
B SVC
C Elevation of the ipsilateral diaphragm
D Pericardial fat pad
E Abnormal lucency at ipsilateral base

1-3: Which of the following diseases can demonstrate bi-directional shunting? Please answer the with TRUE or FALSE
a. T or F L transposition.
b. T or F D transposition.
c. T or F Pulmonary atresia with intact ventricular septum.
d. T or F PDA.
E T or F TAPVR.

2-1: Which ONE is NOT a cause of high output cardiac failure?
A Thyrotoxicosis.
B Sickle cell anemia.
C Aortic insufficiency.
D Aortocaval fistula.
E Pulmonary AVM.

2-2: Alveolar microlithiasis is associated with which of the following? Please answer with TRUE or FALSE
a. T or F Hypercalcemia.
b. T or F Familial occurrence.
c. T or F Intense uptake on bone scintigraphy.
d. T or F IV drug abuse with talc-containing drugs.

2-3: Which ONE is TRUE regarding extramedullary hematopoiesis involving the thorax?
A Often seen in children
B More often in the mid to lower rather than upper thoracic spine
C Commonly causes polycythemia
D Hypervascular lesion

3-1: Which of the following are causes of pulmonary edema?
a. T or F Left atrial myxoma.
B T or F Mitral stenosis.
c. T or F Mitral regurgitation.
d. T or F Aortic stenosis.

3-2: Which ONE of the following regarding fracture/rupture of the bronchus is FALSE?
A Occurs within one to two centimeters of the carina
B Most commonly presents with pneumomediastinum
C Often associated rib fractures
D More common than tracheal rupture
E Is often associated with pulmonary artery injury

3-3: Which of the following are associated with cystic changes in the lung apices? Please answer with TRUE or FALSE.
a. T or F Histiocytosis X.
b. T or F Lymphangioleiomyomatosis.
c. T or F Tuberous sclerosis.
d. T or F Usual interstitial pneumonia.
E. T or F Ritalin lung.

4-1: Which ONE of the following is NOT associated with transient opacities?
A Simple eosinophilic pneumonia (Loeffler's).
B Chronic eosinophilic pneumonia.
C Allergic angiitis granulomatosis.
D Pulmonary hemorrhage

4-2: Regarding miliary tuberculosis, please answer the following with TRUE or FALSE.
a. T or F A negative PPD is extremely rare.
b. T or F Usually a primary focus of infection can be identified.
c. T or F Patients with miliary TB respond more rapidly than those with other types of tuberculosis.
d. T or F The radiographic changes take several weeks to develop.
E T or F Can present with pleural effusions.

4-3: Regarding lung anatomy, which ONE is TRUE?
A The right upper lobe bronchus is the narrowest lobar bronchus
B The apical posterior segment is on the right
C The anteromedial segment is on the right
D The lingula has superior and inferior divisions

train in single best answer even with image

History: Young man with 3 days of chest tightness, dysnpea, fever, and nausea.

what is the possible diagnosis:

A Germ cell tumor.

B Lymphoma.

C Sarcoma.

D Thymic tumor.

E All of the above belong to the differential diagnosis

Can you select the correct answer

A- T or F SVC is occluded.

B T or F Mass is mostly necrotic.

C T or F There is evidence of pericardial involvement.

Can you select the actual diagnosis?

A Germ cell tumor.

B Lymphoma.

C Sarcoma.

D Thymic tumor.

E None of the above.

Key points:

• Diffuse large B-cell lymphoma (DLBCL) is a fast-growing, aggressive form of non-Hodgkin's lymphoma (NHL)

• There are more than 20 types of NHL, DLBCL is the most common type, making up about 30 percent of all lymphomas

• Diffuse large B-cell lymphoma can be fatal if left untreated, but with timely and appropriate treatment, up to half of all patients are curable.

• This subtype of DLBCL within the chest cavity that usually involvse the thymus.

• Primary mediastinal large B-cell lymphoma comprises 7 percent of all diffuse large B-cell lymphomas and accounts for 2.4 percent of all non-Hodgkin's lymphomas. If this subtype of diffuse large B-cell lymphoma recurs, it can cause problems with other organs, including the liver, gastrointestinal tract, kidneys, ovaries, and central nervous system.

• The five-year survival rate of patients with DLBCL is between 26 and 73 percent.

answer: E, C, B

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History: Woman with normal CNS workup has unexplained headaches and sweating

Which choice best characterizes the salient finding, if one if visible?

A Subacute aortic dissection.

B Mesenteric mass.

C Pancreatic mass.

D Adrenal mass.

E Images are within normal limits.

Which ONE of the following does NOT take up MIBG?

a. Neuroblastoma.

b. Carcinoid.

c. Medullary thyroid carcinoma.

d. Paraganglioma.

e. All of the above take up MIBG.

Images from a I123 MIBG scan are shown. Which choice is the MOST LIKELY diagnosis?

a. Adrenal adenoma

b. Adrenal carcinoma

c. Pheochromocytoma.

d. Neuroblastoma.

e. Myelolipoma.

Which ONE of the following does NOT take up MIBG?

a. Neuroblastoma.

b. Carcinoid.

c. Medullary thyroid carcinoma.

d. Paraganglioma.

e. All of the above take up MIBG.

Findings: CT Abdomen shows right adrenal nodule with HU less than 20 on non contrast CT. Nuclear medicine I123 MIBG (24 hour) scan with SPECT demonstrates focal uptake in the right adrenal gland.

Additional clinical history: Patient was also noted to be hypertensive

Differential Diagnosis

• MIBG Uptake
• Pheochromocytoma
• Neuroblastoma
• Carcinoid
• Medullary thyroid carcinoma
• Paraganglioma
• Adrenal MIBG Uptake
• Pheochromocytoma
• Neuroblastoma
• Adrenal Nodule
• Adenoma
• Adrenal carcinoma
• Metastasis
• Hematoma
• Myelolipoma

Discussion

Pheochromocytoma is a catecholamine secreting tumor which may arise in the adrenal gland (90%) or outside the adrenal gland known as paraganglioma. Pheochromocytoma accounts for 0.05-0.2% of hypertension. Typically, symptoms are intermittent. Pheochromocytoma may occur with MEN 2a, 2b, neurofibromatosis, and Von Hippel Lindau. Laboratory tests include plasma metanephrine (96% sensitive, 85% specific) and 24 hour urine catecholamine and metanephrine (87.5% sensitive, 99.7% specific). Imaging studies include CT, MRI, and nuclear medicine. Treatment includes medication alpha and beta receptor blockade and surgical resection.

Radiologic Overview:

CT or MRI may detect adrenal or extra adrenal nodules but are nonspecific for pheochromocytoma. Nuclear medicine imaging can be considered for extra adrenal pheochromocytoma detection or small adrenal nodules.

I-123 metaiodobenzylguanidine, MIBG, is used for pheochromocytoma and neuroblastoma imaging. It is a precursor of norepinephrine and is taken up selectively by the adrenal medulla, the sympathetic autonomic nervous system, and tumors derived from these tissues. Other tumors, such as carcinoid carcinoma and medullary thyroid carcinoma may be visualized, but with relatively low sensitivity; octreotide imaging may be superior for these tumors. In111 octreotide is less sensitive for pheochromocytoma detection.

There is expected normal activity in the spleen, heart, salivary glands and liver. Urinary bladder activity can sometimes be seen due to free radioiodine.

MIBG can be labeled with either I-131 or I-123. Although it is more expensive, I-123 MIBG is the preferred radiopharmaceutical because of much better image quality. Radiation dose to the thyroid gland should be minimized by blocking of thyroidal I-131 uptake with potassium iodide or Lugol's solution. Technetium pertechnetate may be used to block thyroid uptake if using I123 MIBG.

Many drugs interfere with uptake of MIBG, particularly tricyclic antidepressants, sympathomimetics (e.g., pseudoephedrine), and certain antihypertensives (labetalol, reserpine, and calcium channel blockers). An important indicator of an acceptable MIBG uptake is the presence of cardiac activity.