Chest imaging: post-pneumonectomy radiograph: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Chest imaging: post-pneumonectomy radiograph

Sample item

Several weeks after a left pneumonectomy, a chest radiograph shows a completely opaque left hemithorax. Which finding would be expected in a normal post-pneumonectomy state?

AMediastinal shift away from the operated side from the outsetBHyperlucent hemithorax with deviated trachea awayCAir-fluid level that persists above the diaphragm unchangedDMediastinal shift toward the operated side as the space fills with fluid and fibrosis

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Mediastinal shift toward the operated side as the space fills with fluid and fibrosis

After pneumonectomy, the empty space gradually fills with fluid over weeks, and the mediastinum shifts toward it as the remaining lung herniates across. A sudden shift away, or a fall in fluid level, suggests bronchopleural fistula or infection.

Option by option

A. Mediastinal shift away from the operated side from the outset
A shift away would be abnormal and suggests bleeding or empyema under pressure.
B. Hyperlucent hemithorax with deviated trachea away
A hyperlucent hemithorax means air and is abnormal weeks later.
C. Air-fluid level that persists above the diaphragm unchanged
A static air-fluid level does not fit the normal gradual filling.
D. Mediastinal shift toward the operated side as the space fills with fluid and fibrosis (correct)
Correct. Shift toward the operated side occurs as the space fills.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is D, Mediastinal shift toward the operated side as the space fills with fluid and fibrosis. After pneumonectomy, the empty space gradually fills with fluid over weeks, and the mediastinum shifts toward it as the remaining lung herniates across.

Why is "Mediastinal shift away from the operated side from the outset" not the answer?

A shift away would be abnormal and suggests bleeding or empyema under pressure.

Why is "Hyperlucent hemithorax with deviated trachea away" not the answer?

A hyperlucent hemithorax means air and is abnormal weeks later.

Why is "Air-fluid level that persists above the diaphragm unchanged" not the answer?

A static air-fluid level does not fit the normal gradual filling.

What concept does this question test?

It tests Chest imaging: post-pneumonectomy radiograph in Radiology. A sudden shift away, or a fall in fluid level, suggests bronchopleural fistula or infection.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Chest imaging: post-pneumonectomy radiograph?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.