Citation, DOI & article data
Nipple shadows are apparent on ~7.5% (range 3.5-11%) of frontal chest x-rays 1.
It has been proposed by Miller et al. that solitary pulmonary nodules that reach some or all of the following criteria be considered nipple shadows 2:
- bilateral and symmetric
- "fuzzy" margins or radiolucent "halo"
- sharp lateral border and poorly defined medial border (may be present only on PA projections 3)
- nodules are in a characteristic position:
- male: between the 5th and 6th ribs anteriorly
- female: at the inferior aspect of the breast shadow
- were not present on a very recent film
- prominent nipples may be visible on a lateral projection
However, if there is doubt whether a nodular opacity represents a nipple shadow or not, a repeat chest x-ray with nipple markers should be performed 4, albeit at a financial cost and further radiation dose to the patient.
There is always the rare occurrence of a real solitary pulmonary nodule being overshadowed by a nipple shadow.
On chest radiograph the following features are present:
- nipple shadows are nodular opacities that are consistent in shape, size and position 1,2:
- oval or round
- 5-15 mm in diameter
- between the 9th and 10th ribs posteriorly or the 5th and 6th ribs anteriorly
- tend to have incomplete margins due to their attachment to the chest wall 4
- 1. 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
- 2. Miller WT, Aronchick JM, Epstein DM et-al. The troublesome nipple shadow. AJR Am J Roentgenol. 1985;145 (3): 521-3. doi:10.2214/ajr.145.3.521 - Pubmed citation
- 3. Ferris RA, White AF. The round nipple shadow. Radiology. 1976;121 (2): 293-4. Pubmed citation
- 4. Reed JC. Chest Radiology. Mosby. ISBN:1437723454. Read it at Google Books - Find it at Amazon
- 5. Polnitsky CA, Toffler RB, Sherter CB. Nipple shadows in X-ray films. The New England journal of medicine. 305 (16): 956-7. doi:10.1056/NEJM198110153051616 - Pubmed
- 6. Moss ML. More on nipple shadows in x-ray films. The New England journal of medicine. 306 (3): 176. Pubmed