Presentation
CXR performed as part of sepsis workup.
Patient Data

Lungs and pleural spaces clear. Normal cardiomediastinal contour.
Density projects adjacent to the right paratracheal stripe, over the right sixth rib head.

Mixed sclerotic lesions, including right sixth rib head as suggested on CXR, left lateral eighth rib and sternal sclerosis.

Extensive multifocal tracer uptake including sternum, right sixth rib, left sacrum and femoral necks.
Case Discussion
On investigation, the patient's PSA was elevated and a diagnosis of metastatic prostate cancer was made.
When thinking about posterior mediastinal masses in an exam situation, don't forget the bones!