Button mimicking a coin lesion

Case contributed by Craig Hacking
Diagnosis certain


Pre CABG and AVR workup

Patient Data

Age: 80 years
Gender: Female

Initial chest X-ray:

A 10 mm ovoid nodular opacity is projected over the lower half of the medial end of the left clavicle which is not resolved on the lateral projection. This may be associated with the sternoclavicular or degenerative first costochondral joint, it may represent pulmonary or pleural nodule or it may be outside the patient.

Mild peribronchial thickening bilaterally. The pleural spaces are clear. Heart size and mediastinal contours are normal. No pneumothorax or free subdiaphragmatic gas.

Repeat chest X-ray:

A repeat frontal chest x-ray with the patient's gown removed shows absence of the left apical nodule and hence a clothing-related artifact.

Case Discussion

Beware of clothing mimicking pathology!

It is always wise to ask the radiographer if the patient had clothing in the field of view.

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