Neurofibromatosis

Multiple nodular opacities overlie lung parenchyma.
Careful inspection reveals the nodules to be on the skin surface.
- Detailed views of the right axilla and right lung base confirm this.
  - Note the rib fracture.

Discussion:

Many students fail to consider the possibility that a "lung nodule" may be a skin lesion.
- The same problem arises in other areas of radiology, such as mammography.
The answer is to obtain, whenever possible, an orthogonal view.
- This is just one more reason to discourage "portable" chest radiographs.
CT scan of the chest may be necessary when multiple nodules are involved.

Radiographic findings are compatible with, but not specific for, the cutaneous manifestations of Neurofibromatosis.

You may wish to review some facts regarding Neurofibromatosis:

Autosomal dominant neurocutaneous disease.
Cutaneous nodules can simulate lung nodules.
- 5% of patients have neurofibrosarcomas. These can metastasize to the lungs.
Other chest findings:
- Bilateral interstitial fibrosis.
- Paravertebral masses.
- Widened neural foramena and posterior scalloping, T-spine.
- Rib notching.
- "Twisted rib" deformity.
- Short segment, sharp angle scoliosis.
- Lateral meningoceles.
- Pheochromocytomas.
Neurofibromatosis is a multi-organ disease.
- Neuro, GI, GU, and Bone radiology textbooks can be consulted for more information.

Ref: Armstrong, P., et. al., Imaging of Diseases of the Chest, 2nd ed, Mosby, St. Louis, MO, 1995, pp. 589-591.