Radiology: AIIMS May 2013

Q-1. Which stage of neuro-cysticercosis doesn’t show edema on CT scan?
a) Vesicular stage
b) Colloid stage
c) Granular nodular stage
d) Calcified nodular stage

Answer: Calcified nodular stage
Radiographic features of various stages of neuro-cysticercosis:
Cyst with dot sign
No enhancement is typical, although very faint enhancement of the wall and enhancement of the Scolex may be seen
Colloidal vesicular:
Cyst fluid becomes turbid
Surrounding edema
Cyst and the wall becomes thickened and brightly enhances
Scolex can often still be seen as an eccentric focus of enhancement
This is the most symptomatic stage
Granular nodular:
Edema decreases
Cyst retracts
Enhancement persists but is less marked
Nodular calcified:
End stage quiescent calcified cyst remnant
No edema
No enhancement on CT

Q-2. A patient presents with cough and fever. On X-ray examination, a homogenous opacity silhouetting the right heart border is seen. Which part of lung is involved?
a) Medial segment of right middle lobe
b) Lateral segment of right middle lobe
c) Anterior segment of right upper lobe
d) Medial basal segment of right lower lobe

Answer: Medial segment of right middle lobe
In radiology, the silhouette sign refers to the loss of normal borders between thoracic structures.
It is usually caused by an intra-thoracic radio-opaque mass that touches the border of the heart or aorta.
It may occur, for example, in right middle lobe syndrome, where the right heart margin is obscured, and in right lower lobe pneumonia, where the border of the diaphragm on the right side is obscured, while the right heart margin remains distinct.
Silhouette————Contact with lung
Hemi-diaphragms-Basal segment of lower lobes
Aortic Knob- Apico-posterior segment of LUL
Left Heart Border- Lingula (Anterior)
Rt Heart Border-Rt medial lobe (RML)
Upper Lt Heart Border- Anterior segment of LUL
Upper Rt Heart Border- Anterior segment of RUL
Ascending Aorta- Anterior segment of RUL

Q-3. An 8 years old child left sides flank pain and mental retardation. On ultrasound, a hyper-echoic lesion in the right kidney and multiple lesions in the liver are noted. CT examination of the abdomen revealed -30 to -50 HU densities of these lesions. What is most probable diagnosis?
a) von Hippel Lindau Syndrome
b) Tuberous sclerosis
c) Hereditary hemangioblastomas
d) Autosomal recessive polycystic kidney disease

Answer: Tuberous sclerosis
Tuberous sclerosis complex is a rare genetic disease that causes noncancerous (benign) lesions to grow in many parts of the body, such as the skin, brain, liver and kidneys.

Q-4. Which of the following gland tumor hot spot on tc99 pertechnate scan is?
a) Adeno-lymphoma
b) Adenoid cystic carcinoma
c) Adenocarcinoma
d) Pleomorphic adenoma

Answer: Adeno-lymphoma
All salivary tumors produce a cold spot on tc99 pertechnate scan except adeno-lymphoma and onco-cytoma.
Warthin’s tumor or Warthin’s tumour, also known as papillary cystadenoma lymphomatosum, monomorphic adenoma or adeno-lymphoma, is a type of benign tumor of the salivary glands.
Warthin’s tumor is the second most common benign parotid tumor.
The tumour presents as a soft, cystic lump.
It alone, among salivary neoplasms, will concentrate technetium 99m.
Treatment is by superficial parotidectomy. Recurrence is rare but a satellite lesion may enlarge and present as another tumour. Prognosis after operation is good.