Lung nodule: film edge

Case contributed by Dr Ian Bickle

Presentation

Left shoulder pain. No history of trauma. Joint abnormality?

Patient Data

Age: 65 years
Gender: Female
X-ray

No bone or joint abnormality.

Minor left apical fibrosis.

2cm nodule in the right upper lobe just inferior to the right first anterior rib.

X-ray

2cm well defined opacity in the right upper lobe between the 1 and 2nd rib ends.

Minor left apical fibrosis.

Normal mediastinal contours.

Heart size normal.

Case Discussion

A good case to highlight one's approach to plain radiography reporting.

1.  Basic, but for a purpose:  yes it's now considered a basic investigation, but give the radiograph respect.  They do herald pathology.

2.  Clinical Query Blindness:  don't just focus on the immediate clinical query.   Check all that is given. 

3.  Film Edge:   ignoring the film edge is potentially dangerous.  Images have to start and stop somewhere.

4.  Projection Bias:   Yes its not a film to look at the chest.  Yes this could potentially be artifact from positioning, but don't ignore it.   Do something to prove or repute concerns, like an appropriate projection for clarification.

5.  Gut Instinct:  If it makes you feel uncomfortable on first sight it probably is something.

 

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Case information

rID: 59006
Published: 17th Mar 2018
Last edited: 14th Aug 2019
System: Chest
Tag: tutong
Inclusion in quiz mode: Included
Institution: Rotherham Foundation Hospital Trust

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