Do the nodules detected in chest X‐rays always indicate a disease of lung parenchyma?

Abstract

A fracture in the radial/ulnar shaft of the left forearm, bilateral multiple rib fractures and a left haemopneumothorax were found in a 61-year-old male patient at an external clinic due to falling from height. After having been administered a left tube thoracostomy, he was referred to our clinic for further treatment. In the patient’s posteroanterior chest X-ray, which was sent to our clinic digitally before his transportation, bilateral multiple well-circumscribed nodules of various sizes were observed, suggesting the presence of different additional pathologies such as metastatic lung tumours, granulomatous diseases or infections (Fig. 1). During the physical examination after being admitted into the clinic, widespread skin nodules of various sizes were found all over his body (Fig. 2). The recollection heard from the patient and his family revealed that the patient and his brother were being treated for neurofibromatosis type 1. In thoracic tomography, no pathology was observed in the lungs and it was concluded that his skin nodules caused the pathological appearance in chest X-ray (Fig. 3). Affecting approximately 1 in 3500 live births, neurofibromatosis type 1 is an autosomal dominant, multisystem disorder with variable expressions. This disease is characterized by von Recklinghausen with multiple café-au-lait spots, axillary or inguinal freckling, cutaneous neurofibromas, plexiform neurofibromas, iris Lisch nodules, optic glioma and bony abnormalities. Neurofibromas are tumours of the nerve sheath comprised of Schwann cells, fibroblasts, perineural cells, mast cells, axons and blood vessels. They can occur in any part of the body in various shapes and sizes. In general, cutaneous neurofibromas are dome-shaped, soft, fleshy, skin coloured to slightly hyperpigmented lesions developing more commonly in teenagers and adults. As in this case, neurofibromas that can be in large numbers and great sizes covering the thoracic