Diffuse Lung Disease, Interstitial Pneumonias, and Occupational Disorders — WACS Viva & Clinical Scenarios (Chest and Cardiovascular Imaging)

Exam-style diffuse lung disease, interstitial pneumonias, and occupational disorders viva scenarios with examiner probes and model answers for Radiology…

Scenarios covered

• SCENARIO 1: A 64-year-old male with a 30 pack-year smoking history presents with progressive exertional dyspnoea, non-productive cough, and digital clubbing. High-Resolution Computed Tomography (HRCT) of the chest demonstrates bilateral, peripheral, subpleural, and basal-predominant reticular opacities, traction bronchiectasis, and clustered subpleural cystic spaces arranged in multiple layers with shared thick walls measuring 3 to 10 mm. There are no extensive ground-glass opacities, centrilobular nodules, or mosaic attenuation. Provide a structured radiological report, classify the HRCT pattern accordin
• SCENARIO 2: A 36-year-old female presents with erythema nodosum, bilateral ankle arthralgia, and mild exertional breathlessness. Plain posteroanterior chest radiography demonstrates symmetrical bilateral hilar enlargement and right paratracheal lymphadenopathy without visible parenchymal opacities. Thoracic HRCT reveals multiple well-defined 2 to 4 mm micronodules distributed predominantly along the bronchovascular bundles, interlobular septa, and subpleural fissures. State the radiographic stage according to the Siltzbach classification, define the CT nodular distribution pattern, and describe the classi
• SCENARIO 3: A 54-year-old underground gold miner with 20 years of occupational exposure presents with worsening breathlessness and low-grade fevers. Chest radiography reveals bilateral symmetric upper lobe nodular opacities, progressive massive fibrosis with conglomerate masses, and peripheral rim-like eggshell calcification of hilar lymph nodes. A newly developed thick-walled cavity is identified within the right conglomerate mass. Select the most critical superimposed complication that must be urgently evaluated, identify the underlying occupational pneumoconiosis, and outline its key differential diagn
• SCENARIO 4: A clinician requests an HRCT chest scan for a 48-year-old pigeon breeder suspected of having chronic hypersensitivity pneumonitis. Formulate the comprehensive HRCT acquisition protocol including slice thickness, reconstruction algorithm, patient positioning, and dynamic respiratory maneuvers. Detail the three-density pattern on inspiratory scans and the dynamic expiratory CT findings that confirm small airway involvement.
• SCENARIO 5: Match the following characteristic HRCT thoracic signs and distributions to the most appropriate diagnosis from a list comprising Cryptogenic Organizing Pneumonia, Systemic Sclerosis-associated NSIP, Lymphangioleiomyomatosis, Desquamative Interstitial Pneumonia, and Pulmonary Langerhans Cell Histiocytosis: Case A: Bilateral symmetric ground-glass opacities and fine reticulation with notable subpleural sparing at the lung bases, associated with a patulous, dilated fluid-filled oesophagus; Case B: Peripheral and peribronchovascular consolidations and ground-glass attenuation surrounded by a comp