Correct!
2. The metallic focus resides in the heart
The metallic focus projects over the heart and chest wall on the frontal image, just cranial to the diaphragm. On this projection, the metallic focus resides too medially to be located within the left lung since the left lower lobe is located posterior to the heart and the lingua is located lateral to the heart. In other words, the heart’s presence in the medial left thorax essentially excludes the left lung’s ability to occupy this portion of the thorax; therefore, any object or structure projecting in this region at chest radiography will likely not reside within the lung. On the lateral chest radiograph, the metallic focus projects over the heart and left lung, and resides too posteriorly to be located within the chest wall, either the sternum or medial costochondral junction (the medial portion of which generally roughly resides in the same plane as the sternum on the lateral projection). Combining these two assessments, the heart is the one location for the metallic fragment that is common to both projections, and therefore is the most likely location for this metallic focus.
Which of the following represents an appropriate step for the evaluation of this patient? (Click on the correct answer to proceed to the fiourth of eight panels)