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Nipple markers

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

See also

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