Chest and cardiac imaging: retrosternal goitre on CT: 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 and cardiac imaging: retrosternal goitre on CT

Sample item

A 60-year-old woman has a smooth upper mediastinal mass that is continuous with the neck and deviates the trachea. Which CT feature best supports a thyroid origin?

ALow attenuation with rim enhancement and central necrosisBWater density with a non-enhancing thin wallCFat attenuation with a thin calcified capsuleDHyperattenuation before contrast with avid, prolonged enhancement

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

The answer and the reasoning

D. Hyperattenuation before contrast with avid, prolonged enhancement

Thyroid tissue is naturally dense because of its iodine content, so it is hyperattenuating on the unenhanced scan and enhances strongly and for long. Continuity with the cervical gland and tracheal displacement complete the picture.

Option by option

A. Low attenuation with rim enhancement and central necrosis
Rim enhancement with necrosis suggests a suppurative or necrotic node mass, not a goitre.
B. Water density with a non-enhancing thin wall
Water density with no enhancement suggests a benign cyst such as a pericardial or bronchogenic cyst.
C. Fat attenuation with a thin calcified capsule
Fat with calcification points to a mature teratoma, which sits in the anterior mediastinum without cervical continuity.
D. Hyperattenuation before contrast with avid, prolonged enhancement (correct)
Correct. Iodine makes thyroid tissue dense before contrast, and it enhances avidly afterwards.

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, Hyperattenuation before contrast with avid, prolonged enhancement. Thyroid tissue is naturally dense because of its iodine content, so it is hyperattenuating on the unenhanced scan and enhances strongly and for long.

Why is "Low attenuation with rim enhancement and central necrosis" not the answer?

Rim enhancement with necrosis suggests a suppurative or necrotic node mass, not a goitre.

Why is "Water density with a non-enhancing thin wall" not the answer?

Water density with no enhancement suggests a benign cyst such as a pericardial or bronchogenic cyst.

Why is "Fat attenuation with a thin calcified capsule" not the answer?

Fat with calcification points to a mature teratoma, which sits in the anterior mediastinum without cervical continuity.

What concept does this question test?

It tests Chest and cardiac imaging: retrosternal goitre on CT in Radiology. Continuity with the cervical gland and tracheal displacement complete the picture.

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 and cardiac imaging: retrosternal goitre on CT?

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.