Findings: PA radiograph shows numerous pointed opacities projected over the right upper lung (A, circle). They are denser than the ribs, which is a clear indication of artifacts. Close examination of the right apex shows a tubular shadow that extends into the soft tissues of the neck (A, arrows), suggesting a hair braid. The patient was examined, and a ponytail rubber holder was removed (insert). After removal, the chest presents a normal aspect (B).

Final diagnosis: ponytail holder simulating a pulmonary lesion.

Congratulations to MK, who was the first to suggest the correct diagnosis. And my appreciation to Ren and Mauro for cooperating with the blog.

Teaching point: remember that opacities in the upper lungs may be related to hair implements. I saw recently another case of a braid holder thought to be a foreign body by the paediatrician (C, arrows).