Pulmonary Infections, Tuberculosis, and Endemic Thoracic Pathologies — WACS Viva & Clinical Scenarios (Chest and Cardiovascular Imaging)

Exam-style pulmonary infections, tuberculosis, and endemic thoracic pathologies viva scenarios with examiner probes and model answers for Radiology candidates.

Scenarios covered

• SCENARIO 1: An adult patient presents with chronic cough, low-grade evening fevers, weight loss, and episodic haemoptysis. Chest radiograph and subsequent high-resolution computed tomography (HRCT) demonstrate right apical and posterior segment thick-walled cavitary lesions surrounded by branching centrilobular micronodules forming a tree-in-bud appearance, alongside ipsilateral volume loss and apical pleural thickening.
• SCENARIO 2: A 34-year-old immunocompromised patient with advanced human immunodeficiency virus (HIV) infection presents with worsening exertional dyspnoea, non-productive cough, and severe hypoxaemia. Frontal chest radiography and non-contrast thoracic HRCT show bilateral, symmetric, perihilar ground-glass opacities with peripheral and subpleural sparing, accompanied by several thin-walled upper lobe pneumatoceles.
• SCENARIO 3: A 42-year-old farmer from an endemic pastoralist region presents with right-sided pleuritic chest discomfort and occasional haemoptysis. Plain chest radiography and contrast-enhanced thoracic CT reveal a large, well-defined, unilocular fluid-attenuation cyst in the right lower lobe showing detachment and floating of the collapsed internal germinative and laminar membranes, classical of the water lily (Camalote) sign.
• SCENARIO 4: A 28-year-old inpatient with unresolved bacterial pneumonia develops worsening pyrexia, right-sided pleuritic chest pain, and leukocytosis. Thoracic ultrasound and contrast-enhanced chest CT demonstrate an encapsulated, lenticular-shaped pleural collection with thick, brightly enhancing visceral and parietal pleural layers separated by fluid (split pleura sign) and internal fibrinous septations.
• SCENARIO 5: A 38-year-old patient with a prior history of treated pulmonary tuberculosis presents to the emergency room with life-threatening massive haemoptysis (>400 mL within 6 hours). Contrast-enhanced multidetector CT angiography of the chest reveals a 6 mm hyperenhancing outpouching arising from a branch of the right pulmonary artery located within the fibrous wall of an old upper lobe tuberculous cavity.