Lo, the Ever Confounding Nipple Shadow!

Overview

Journal Malays Fam Physician

Specialty Public Health

Date 2020 Dec 17

PMID 33329866

Authors

W H Boo

Y C Chan

Affiliations

Soon will be listed here.

Abstract

The discovery of a solitary pulmonary nodule (SPN) on chest imaging can be alarming for both the clinician and the patient. In the absence of a uniform guideline, managing SPN is nothing short of challenging for primary care physicians (PCPs). We present a case here of a patient presenting with prolonged cough who also displayed unilateral SPN on her chest radiograph. Through further examination, this presence was later shown to be a nipple shadow simulating SPN, and the patient was spared unnecessary testing and psychological distress.

References

Ohwada A, Sato K, Tamori Y, Yamada T . Visible male nipple shadows in chest radiographs. Respirology. 2005; 10(1):111-5. DOI: 10.1111/j.1440-1843.2005.00653.x. View

HOLIN S, DWORK R, Glaser S, RIKLI A, STOCKLEN J . Solitary pulmonary nodules found in a community-wide chest roentgenographic survey; a five-year follow-up study. Am Rev Tuberc. 1959; 79(4):427-39. DOI: 10.1164/artpd.1959.79.4.427. View

Zhang X, Yan H, Lin J, Wu Z, Liu J, Cao X . Comparison of three mathematical prediction models in patients with a solitary pulmonary nodule. Chin J Cancer Res. 2015; 26(6):647-52. PMC: 4279199. DOI: 10.3978/j.issn.1000-9604.2014.11.02. View

Iaccarino J, Simmons J, Gould M, Slatore C, Woloshin S, Schwartz L . Clinical Equipoise and Shared Decision-making in Pulmonary Nodule Management. A Survey of American Thoracic Society Clinicians. Ann Am Thorac Soc. 2017; 14(6):968-975. PMC: 5566306. DOI: 10.1513/AnnalsATS.201609-727OC. View

Gould M, Ananth L, Barnett P . A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules. Chest. 2007; 131(2):383-8. PMC: 3008547. DOI: 10.1378/chest.06-1261. View

FLOWERS Jr W . Superimposition of nipple shadows and real lesions. AJR Am J Roentgenol. 1997; 168(6):1624. DOI: 10.2214/ajr.168.6.9168751. View

McNulty W, Cox G, Au-Yong I . Investigating the solitary pulmonary nodule. BMJ. 2012; 344:e2759. DOI: 10.1136/bmj.e2759. View

Hansell D, Bankier A, MacMahon H, McLoud T, Muller N, Remy J . Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008; 246(3):697-722. DOI: 10.1148/radiol.2462070712. View

Elia S, Loprete S, De Stefano A, Hardavella G . Does aggressive management of solitary pulmonary nodules pay off?. Breathe (Sheff). 2019; 15(1):15-23. PMC: 6395991. DOI: 10.1183/20734735.0275-2018. View

10.

Miller W, Aronchick J, Epstein D, Gefter W . The troublesome nipple shadow. AJR Am J Roentgenol. 1985; 145(3):521-3. DOI: 10.2214/ajr.145.3.521. View

11.

Comstock G, Vaughan R, Montgomery G . Outcome of solitary pulmonary nodules discovered in an x-ray screening program. N Engl J Med. 1956; 254(22):1018-22. DOI: 10.1056/NEJM195605312542202. View

12.

Patel V, Naik S, Naidich D, Travis W, Weingarten J, Lazzaro R . A practical algorithmic approach to the diagnosis and management of solitary pulmonary nodules: part 1: radiologic characteristics and imaging modalities. Chest. 2013; 143(3):825-839. DOI: 10.1378/chest.12-0960. View

13.

Al-Ameri A, Malhotra P, Thygesen H, Plant P, Vaidyanathan S, Karthik S . Risk of malignancy in pulmonary nodules: A validation study of four prediction models. Lung Cancer. 2015; 89(1):27-30. DOI: 10.1016/j.lungcan.2015.03.018. View

14.

Moss M . More on nipple shadows in x-ray films. N Engl J Med. 1982; 306(3):176. DOI: 10.1056/nejm198201213060318. View

15.

Wu G, Consunji M, Nelson R, Yeung K, Sun C, Kim J . Perspectives on Managing Solitary Pulmonary Nodules: A Survey of Primary Care Physicians. Semin Thorac Cardiovasc Surg. 2017; 29(3):391-405. PMC: 8840818. DOI: 10.1053/j.semtcvs.2017.05.012. View

16.

GOOD C, Wilson T . The solitary circumscribed pulmonary nodule; study of seven hundred five cases encountered roentgenologically in a period of three and one-half years. J Am Med Assoc. 1958; 166(3):210-5. DOI: 10.1001/jama.1958.02990030008003. View

17.

Polnitsky C, Toffler R, Sherter C . Nipple shadows in X-ray films. N Engl J Med. 1981; 305(16):956-7. DOI: 10.1056/NEJM198110153051616. View

18.

Henschke C, McCauley D, Yankelevitz D, Naidich D, McGuinness G, Miettinen O . Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet. 1999; 354(9173):99-105. DOI: 10.1016/S0140-6736(99)06093-6. View

19.

Ferris R, White A . The round nipple shadow. Radiology. 1976; 121(2):293-4. DOI: 10.1148/121.2.293. View