A thyroid mass was identified.  The patient was sent for a thyroid sonogram and it was determined to be a benign adenoma.  The patient was followed for the next two years and there was no change to the adenoma and therefore, no surgery was indicated.  The point of including this non-cancer related finding is to emphasize that patients can have “ticks and fleas”.  Don’t get so focused on one finding that you miss other conditions in the same patient.

The patient had chest radiographs taken because of respiratory complaints due to the lung fibrosis and pleural thickening that was a consequence of cancer treatment.  I include these images to show the importance of orthogonal views for any radiographic study.  Note that the surgical clips overlap the underlying lung structures and thus it cannot be determined from this one view if the clips are superficial, in the lung fields, or vascular clips.  

Where do you think these clips are located?