A good learning case on several levels for a fairly common pathology.

1. Alert system: all institutional shoulds have alert systems and methods for ensuring these are acted upon. This abnormality was on the initial chest x-ray and reported.
2. Radiological sign: sure the radiologist can just say it's abnormal and 'do a CT' but it's enjoyable to see a radiological sign on plain x-ray.
3. CT is not always needed and the greater time and people involved to biopsy a lung mass.
4. Institutional and self-reflection: Could we have done better for this patient? If so how, and can we implement change for future better practice?