my good friend José Luis López Moreno gave me this case: preoperative chest radiographs for hand surgery in a 39-year-old woman.
What do you see?
Com back on Friday to see the answer!
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Findings: PA radiograph shows a rounded opacity in the periphery of the left lung
(A, arrow) that seems to be calcified. Cone down view shows a whorled pattern (B, arrow). A braid is visible in the left supraclavicular area (A, red arrow). Lateral view (not shown) is unremarkable.
Scout view of the CT does not show the apparent lung lesion, which is not visible in the axial view of the lung (D).
The technician that took the chest radiograph told us that the patient had a long braid with a rubber at the end.
Final diagnosis: hair braid simulating a lung nodule
Congratulations to MK who was the first to suggest the right diagnosis. Kudos for effort to Coffee.
I must confess that I was fooled when showed this case. Despite noticing the braid in the left supraclavicular area (A, red arrow) I failed to connect it to the apparent lung nodule. I suspected a skin artifact, without excluding an osteochondroma of rib or scapula.
Teaching point: after showing three braid artifacts in the blog (case 109, 172 and 191), I missed the fourth one.
Nobody is perfect!
12 thoughts on “Cáceres’ Corner Case 201 – SOLVED!”
popcorn like nodular calcification superposed on the left 4th costal and medial scapular borders on PA radiograph
Nodular opacity with coarse calcification partially superimposed on the anterior arch of the 4th left rib and on the medial aspect of the body of scapula.
Abnormal contour if ascending aorta and aortic arch with indistinct descending aorta. Inferior rib notching on left side involving 3,4,5 ribs. Differential include aortic coarctation with aberrant right subclavian artery and childhood Blalock Tausing shunt procedure.
– Nodular opacity with internal coarse calcification at left mid lung zone, overlying at left anterior 4th shadow and scapular shadow.
– Suspectd abnormal tortuous density at left supra-scapular region, might be artifact or true pathology.
Might be hair artifact.
What sort of artifact?
there is hyperlucency over the right upper zone seen on frontal radiograph, and dilated thickebed wall bronchus within it, on the lateral radiograph there is triangular opacity over the heart border… i think it is right middle lobe collapse with over inflation of upper lobe. the calcification over the left lung may be artifact as it not seen on lateral view!
can be other causes of lobar overinflation, congenital, intrabronchial lesion.
CT chest should be the next step!
The patient has a braid in her hair with a rubber band in her distal portion.
Nodular well defined lesion projected over 4th left rib/medial border of scapula with coarse calcifications (maybe ring and arcs calcifications suggesting condroid lesion such rib enchondroma).
This lesion is not clearly visible in lateral view, so I assume it is extrapleural.
Moreover, in left supraescapular region is visible some kind of artifact, maybe hair (and rubber) artifact.
Hair tuft artefact in left supra clavicular region with design type opacity along medial border of left scapula likely plastic artefact of hair clip.
Cortical contours of scapula and ribs are normal.
Pleura and surrounding lung parenchyma are normal.
good afternoon ,
the projected image on the pulmonary field corresponds to an artefactual structure
the object is on the thoracic wall
in sucutaneous cell tissue foreign body? ( piercing maybe).