Findings: PA radiograph shows an ill-defined opacity in the left lung, running from top to bottom (A, white arrows). The opacity extends towards the neck (A, red arrow), which suggests that it is external to the lung. There are two nodules in the lower lungs that correspond to the nipples (A, yellow arrows). Lateral view shows an elongated opacity in the back of the chest (B, arrows).
A photo of the patient (C) confirms that a long braid is the cause of the opacity. PA radiograph after lifting the braid shows a normal chest (D).
Final diagnosis: hair braid simulating a pulmonary infiltrate.
Congratulations to MK, who was the first to suggest the diagnosis.
Teaching point: remember that long hair may project over the lung, simulating pulmonary nodules or infiltrates. The clue to the diagnosis lies in recognizing that the abnormality extends to the neck.