Presentation
Chronic smoker with complain of fever, cough, and shortness of breath for 3 days.
Patient Data
Small well-defined nodular density projected over the right mid-lung zone; nature?
Clear left lung and bilateral costophrenic angles. Normal heart size.
Differential diagnosis includes solitary pulmonary nodule (e.g. granuloma, hamartoma, or solitary metastasis) or bone lesion (e.g. solitary sclerotic metastasis, or benign osseous lesion like a bone island/enostosis).
A small densely sclerotic lesion with thorny radiation margins is seen in the inferior angle of the right scapula.
Mildly hyperinflated lungs (likely due to chronic obstructive pulmonary disease) and mild bronchiectasis.
Patchy opacity in LLL, RUL, and RML. No suspicious pulmonary mass/nodule, pleural/pericardial effusion, pneumothorax/pneumomediastinum, or mediastinal lymphadenopathy is seen.
Osteopenia and degenerative changes are seen in the visualized skeleton.
No gross interval change is seen in the size of the scapular lesion.
Case Discussion
This lesion is corresponding to the nodular density seen in the chest radiograph.
It has average, maximum, and minimum CT attenuation values of 1081, 1179 & 913 HU, respectively, and is likely an enostosis/bone island.