LETTER

Letter to the Editor
Chest radiograph:

'Let the reader
beware'

To the Editor: Enclosed is a photo-
graph of a plain film chest radiograph
showing a small metallic skull and
crossbones projected over the left
clavicle and into the left upper upper
lung field (Fig. 1).

The skull and crossbones are due
to a small metal charm worn around
the neck of the patient, with the clasp
of the necklace also visible.

I have entitled the photograph:
'Let the reader beware: as a general
reminder of the need for eternal vigi-
lance in our profession.

I enjoyed Ian Duncan's 'The ghost
in the machine' in the June 2003 issue
of the SA]R. I feel that such 'Pictorial
Interludes' or photo pages add interest
to journals.

I am not sure why the necklace was
not removed prior to the X-ray being
taken. Our radiographers are well
aware of the need to remove radio-
opaque items, but do not press
patients to remove items from their
persons where patients are reluctant

to do so (unless it is found that the
item specifically obscures an area of
interest).

The chest radiograph shows an old
fracture of the right clavicle and
streaky opacification adjacent to the

right hilum. Sputum culture from the
patient was positive for tuberculosis.

DonEmby
Anglogold Health Services
Western Deep Levels Hospital
Western Levels

31 SA JOURNAL OF RADIOLOGY • November 2003