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Retrocardiac lung nodules (chest radiograph)

Case contributed by Dai Roberts
Diagnosis almost certain

Presentation

Cough and weight loss

Patient Data

Age: 65 years
Gender: Female

Multiple nodules are evident behind the heart in the left lower lobe, concerning for metastasis.  Additionally, there is linear atelectasis in the left lower zone.  The right lung is clear.  Normal heart and mediastinal contours.  

Inverted radiograph

x-ray

Inverting the image can aid in interpretation and can make nodules more apparent.

Case Discussion

Behind the heart is one of the review areas which should be checked when interpretating chest radiographs. Pulmonary nodules have a wide differential diagnosis, and multiple rounded nodules should raise alarm for lung metastasis.  

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