Bronchogenic Carcinoma, Pulmonary Nodules, and Mediastinal Masses — WACS Viva & Clinical Scenarios (Chest and Cardiovascular Imaging)

Exam-style bronchogenic carcinoma, pulmonary nodules, and mediastinal masses viva scenarios with examiner probes and model answers for Radiology candidates.

Scenarios covered

• SCENARIO 1: A 62-year-old male heavy smoker presents with persistent cough and hemoptysis. Contrast-enhanced chest CT demonstrates a 4.2 cm spiculate mass in the right upper lobe directly invading the adjacent 3rd rib and parietal pleura, along with enlarged subcarinal (station 7) lymph nodes measuring 14 mm in short axis, and a solitary 2.0 cm nodule in the left adrenal gland with delayed wash-out of 35 percent. Provide a structured TNM staging report, evaluate surgical resectability, and outline recommended subsequent imaging steps.
• SCENARIO 2: A 48-year-old asymptomatic female undergoes a low-dose CT chest screening, which reveals an incidental 7 mm solid, well-circumscribed non-calcified pulmonary nodule in the right lower lobe, as well as a separate 12 mm part-solid nodule with a 4 mm solid core in the left upper lobe. Outline the Fleischner Society management algorithm and follow-up timeline for both lesions in this low-risk individual.
• SCENARIO 3: A 35-year-old female presents with vague retrosternal chest discomfort. A frontal chest radiograph demonstrates widening of the superior mediastinum with maintenance of the cervicothoracic sign and hilum overlay sign. Contrast-enhanced CT reveals a 6 cm heterogeneous anterior mediastinal mass containing cystic, soft-tissue, and gross fat attenuation components with peripheral curvilinear calcification. Detail the differential diagnosis, radiological features distinguishing the anterior mediastinal compartments, and specific diagnostic imaging signs.
• SCENARIO 4: A 55-year-old male presents with right shoulder pain, ptosis, miosis, and anhidrosis on the right side. Plain radiography reveals asymmetric apical pleural thickening. Explain the optimal imaging modality and protocol to evaluate this suspected superior sulcus (Pancoast) tumour, detailing the critical anatomic landmarks that govern resectability.
• SCENARIO 5: An indeterminate 2.5 cm peripheral pulmonary lesion requires histological characterisation. Discuss the indications, contraindications, pre-procedural planning, procedural steps, and post-procedure complication surveillance for CT-guided percutaneous transthoracic core needle biopsy.