Acute Thoracic Emergencies, Trauma, Pleural Diseases, and Pneumothorax — WACS Viva & Clinical Scenarios (Chest and Cardiovascular Imaging)

Exam-style acute thoracic emergencies, trauma, pleural diseases, and pneumothorax viva scenarios with examiner probes and model answers for Radiology…

Scenarios covered

• SCENARIO 1: Plain Chest Radiograph and Multidetector CT Case Scenario in Blunt Chest Injury: A 34-year-old unrestrained driver involved in a high-speed road traffic crash presents to the emergency department with severe chest pain, paradoxical chest wall movement, and respiratory distress. Portable supine chest radiography reveals multiple fractures involving three consecutive ribs in more than one site each, bilateral patchy opacities, and a deepened lateral costophrenic angle on the right. Contrast-enhanced thoracic CT is subsequently performed. Describe the systematic approach to reporting this trauma
• SCENARIO 2: Emergency Film Interpretation and Cross-Sectional Diagnosis of Traumatic Diaphragmatic Rupture: A 28-year-old male presents with blunt abdominal and lower thoracic trauma following a construction site fall. The initial chest radiograph shows elevation of the left hemidiaphragmatic contour, an obscure left cardiac border, and intrathoracic gas bubbles. Subsequent contrast-enhanced multiplanar CT of the chest and abdomen confirms diaphragmatic disruption. Detail the specific plain film and CT imaging signs that confirm diaphragmatic rupture, differentiate it from congenital eventration or diaphr
• SCENARIO 3: Radiographic and Sonographic Evaluation of Complex Pleural Effusion versus Empyema: A 45-year-old patient with persistent fever, pleuritic chest pain, and non-resolving pneumonia undergoes chest radiography and bedside thoracic ultrasound. Radiographs show a unilateral lenticular, peripheral opacity with obtuse angles to the chest wall. Thoracic ultrasonography reveals thick mobile septations, debris, and fluid hyperechogenicity. State the imaging criteria used to distinguish an empyema from a peripheral lung abscess on contrast-enhanced CT, explain the split pleura sign, and describe the ultr
• SCENARIO 4: Rapid Interpretation of Tension Pneumothorax and Air-Leak Syndromes on Supine Trauma Radiography: A 22-year-old female presents in extremis with acute dyspnoea and tachycardia following penetrating thoracic injury. Due to spinal precautions, only an anteroposterior supine chest radiograph can be acquired. Explain the mechanisms and imaging appearances of the deep sulcus sign, contrast these with the radiographic signs of tension pneumothorax on erect views, and outline the cross-sectional and radiographic signs of pneumomediastinum, pneumopericardium, and extensive subcutaneous emphysema.
• SCENARIO 5: Acute Non-Traumatic Thoracic Emergencies: Radiographic Patterns of ARDS and Massive Hemoptysis: A 50-year-old patient in the intensive care unit develops acute worsening of hypoxia 48 hours following severe pancreatitis. Portable chest radiography demonstrates diffuse, bilateral alveolar infiltrates sparing the costophrenic angles with normal cardiac size. Detail the radiological differential diagnosis distinguishing acute respiratory distress syndrome from cardiogenic pulmonary oedema, and describe the emergency CT angiography protocol and vascular mapping required for bronchial artery emboli