I feel we have been showing very difficult cases lately. To compensate, this week we are presenting an easy case of a 39-year-old woman, asymptomatic.
What do you see? Check the images below, leave your thoughts in the comments section and come back on Friday for the answer.
Findings: the PA radiograph shows two small nodules projected over the anterior third ribs (A, arrows). Another nodule is seen at the lung base (A, red arrow) and there is a fourth one projected over the right scapula (A, yellow arrow). The lateral view shows a small nodule in the soft tissues (B, arrow).
Most of you mentioned accessory nipples because you saw only two symmetrical nodules. Noticing multiple nodules, some of them outside the lungs, suggests nodular skin lesions and brings to mind neurofibromatosis. Breast MRI nicely shows the false accessory nipples as well as other neurofibromas (C-D, arrows).
Final diagnosis: neurofibromatosis
Congratulations to Borsuk, who was the first to suggest the diagnosis
Teaching point: once again, avoid satisfaction of search. Although supernumerary nipples are the initial impression, finding other nodules leads away from this diagnosis and suggests a skin condition.
