Nipple markers can be a useful technique in the evaluation of densities overlying the expected position of the nipple on a chest radiograph.
Not uncommonly a small round opacity projects over the lower thorax on a chest radiograph.
Often, especially in women, this is a 'nipple shadow' - a dense nipple projected over the lung. However, one must be cautious that this is not pathology - in particular a low grade lung malignancy (with potential surgical cure).
Attempts can be made to confirm or refute if it is a nipple:
- is an identical appearance seen on the other side ( i.e. another nipple)
- is the lateral aspect distinct, but the medial aspect not so - more likely a nipple
- is an old film to hand which shows identical appearances and unchanged?
Beware of the unilateral NIPPLE !
If in doubt, recall the patient and repeat the study with nipple markers. This can be a small ball-bearing, unraveled paperclip reformed in a triangle around the nipple or other radio-opaque marker, which is stuck to the chest with the nipple within or the marker on the nipple. On the repeat film
- if the nipple is inside : its nipple
- If its outside its something else (potentially cancer): workup including CT chest is indicated
This article is in need of some more references!
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- 1. Ferris RA, White AF. The round nipple shadow. Radiology. 1976;121 (2): 293-4. Radiology (citation) - Pubmed citation
- 2. Ohwada A, Sato K, Tamori Y et-al. Visible male nipple shadows in chest radiographs. Respirology. 2005;10 (1): 111-5. doi:10.1111/j.1440-1843.2005.00653.x - Pubmed citation
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