The round nipple shadow.
ABSTRACT It is usually easy to distinguish the round nipple shadow from a lesion, especially by means of repeat radiographs with nipple markers. However, the radiologist must occasionally interpret a round density in the lower chest on the basis of a single radiograph or series of radiographs. Fortunately, a nipple shadow usually has a well-defined outer margin and a poorly defined inner margin. Differentiation of a nipple shadow from an extrapleural or pleural lesion is described. Attention to these findings may prevent needless additional study and patient apprehension.
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Article: The troublesome nipple shadow.[Show abstract] [Hide abstract]
ABSTRACT: In a review of 1000 routine chest examinations, the nipple of the male or female breast was visible about 10% of the time. In 14 instances (1.4%), the reviewing radiologist thought that uncertainty of identification warranted additional films. In four of these instances, the density proved to be something other than nipple. In all other instances when a nipple shadow was identified (8.9%), follow-up was not deemed necessary for various, often somewhat subjective reasons. Thus the frequency of erroneous identification of nipples could have been higher. Certainty of nipple identification would have involved considerable cost and inconvenience in repeat examinations. In another group of 500 patients, identification of the nipple with a lead marker on all patients eliminated uncertainty and the necessity for any repeat examinations. The patients placed low cost markers at the time of disrobing. Convenience and certainty were served by this simple maneuver.American Journal of Roentgenology 10/1985; 145(3):521-3. · 2.90 Impact Factor
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ABSTRACT: Annual company employee physical examinations are performed in Japan and include a chest X-ray. Among nodular shadows observed in the lower lung field, nipple shadow is a normal structure to be differentiated, and understanding its characteristics in chest X-rays aids in the interpretation of solitary nodular shadows. Chest X-rays from male employees over 35 years of age at two different companies were analysed for anatomical location, morphology, and size of nipple shadows. If unilateral or bilateral solitary nodular shadows in the lower lung field coincided with the lead nipple marker, we defined it as 'definitive' nipple shadow. If the nodular shadow was observed to be stable for at least 2 years at the typical nipple position, we defined it as 'possible' nipple shadow without confirmation with nipple marking. Typical nipple position, from the analyses of definitive nipple shadows (n = 15), was between the ninth and tenth posterior ribs and within 60 mm from the inner margin of the rib. The nipple was oval or round and did not exceed 15 mm in size. Incidence of definitive and possible (n = 25) nipple shadows was estimated as 3.5% of examined males (n = 1150). Thoracic computed tomography scanning was conducted in four cases, of which three cases involved solitary nodular shadows that did not coincide with the nipple marker, and one was for a newly formed nodular lesion not detected in previous chest X-rays. Visible male nipple shadows are not rare and need to be differentiated among the solitary nodular shadows in the lower lung field.Respirology 02/2005; 10(1):111-5. · 2.78 Impact Factor
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ABSTRACT: Image challenge of the month Narendra et al A 45 year old lady presented with an ulcerated lump in the right breast for the past 2 years. On examination, the lump was located in the central quadrant with involvement of the overlying skin (Figure 1). Multiple matted, hard lymph nodes were palpable in the ipsilateral axilla. Fine needle aspiration from the lump revealed only atypical cells and core needle biopsy was done. The biopsy was reported as invasive lobular carcinoma, grade 3. Her chest radiograph is shown in Figure 2. The liver function tests, ultrasonography of the abdomen and whole body bone-scan did not reveal any distant spread. What is the most probable diagnosis? 1. Pulmonary metastasis 2. Pulmonary Granuloma 3. Nipple shadow 4. Primary lung cancer Figure 2: Chest radiograph (postero-anterior view) 205 Image challenge of the month Narendra et al Image challenge of the Month: Answer The 'solitary pulmonary nodule (SPN)' evident on the chest radiograph was a right-side "nipple shadow". On chest radiographs nipple shadows can mimic pulmonary nodules. 1 They are often bilateral and symmetrical and are easily diagnosed. But, unilateral nipple shadow, such as, that seen in the present patient can pose a diagnostic challenge. In the given clinical scenario, one has to differentiate it from metastasis, as this would alter the line of management. Similarly one has to consider the remote possibility of a second primary in the lung as well as other differential diagnoses for a SPN. A nipple shadow is usually described as 'button like' and is situated in the fourth intercostal space in mid-axillary line. The shadow will have well-defined lateral, superior and inferior margins and a poorly defined medial margin with peripheral air lucency. 2Journal of clinical sciences and research. 01/2012; 1:204-5.