Nipple shadows
Updates to Article Attributes
Body
was changed:
Nipple shadows refer to the silhouettes of the nipples on frontal chest radiographs.
Epidemiology
Nipple shadows are apparent on ~7.5% (range 3.5-11%) of frontal chest x-rays 1.
Pathology
It has been proposed by Miller et al that solitary pulmonary nodules that reach some or all of the following criteria be considered nipple shadows 2:
- bilateral and symmetric
- "fuzzy" margins or
radiolucentradiolucent "halo" - sharp lateral border and poorly defined medial border (may be present only on PA projections 3)
- nodules are in a characteristic position:
- male: between fifth and sixth rib anteriorly
- female: at the inferior aspect of thebreast shadow
- were not present on a very recent film
- prominent nipples may be visible on a lateral projection
However, if there is doubt whether a nodular opacity represents a nipple shadow or not, a repeat chest x-ray with nipple markers should be performed 4, albeit at a financial cost and further radiation dose to the patient.
There is always the rare occurrence of a real solitary pulmonary nodule being overshadowed by a nipple shadow.
Radiographic appearance
Plain radiograph
On chest radiograph the following features are present:
- nipple shadows are nodular opacities that are consistent in shape, size and position 1, 2:
- oval or round
- 5
-15mm-15 mm in diameter - between the 9th and 10th rib posteriorly or the 5th and 6th rib anteriorly
- tend to have incomplete margins due to their attachment to the chest wall 4
Differential diagnosis
- solitary pulmonary nodule
- pleural or extra-pleural lesions 3
-<li>"fuzzy" margins or radiolucent "halo"</li>- +<li>"fuzzy" margins or radiolucent "halo"</li>
-<li>female: at the inferior aspect of the <a href="/articles/breast-shadow">breast shadow</a>- +<li>female: at the inferior aspect of the <a href="/articles/breast-shadow">breast shadow</a>
-</ul><p>However, if there is doubt whether a nodular opacity represents a nipple shadow or not, a repeat chest x-ray with <a href="/articles/nipple-markers">nipple markers</a> should be performed <sup>4</sup>, albeit at a financial cost and further radiation dose to the patient.</p><p>There is always the rare occurrence of a real solitary pulmonary nodule being overshadowed by a nipple shadow. </p><h4>Radiographic appearance</h4><h5>Plain radiograph </h5><p>On chest radiograph the following features are present</p><ul>- +</ul><p>However, if there is doubt whether a nodular opacity represents a nipple shadow or not, a repeat chest x-ray with <a href="/articles/nipple-markers">nipple markers</a> should be performed <sup>4</sup>, albeit at a financial cost and further radiation dose to the patient.</p><p>There is always the rare occurrence of a real solitary pulmonary nodule being overshadowed by a nipple shadow.</p><h4>Radiographic appearance</h4><h5>Plain radiograph</h5><p>On chest radiograph the following features are present:</p><ul>
-<li>5-15mm in diameter</li>- +<li>5-15 mm in diameter</li>
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