You receive a call from an ICU nurse regarding a patient your service is following—a 60-year-old man who was admitted for altered mental status and is being worked up for a possible brain mass. He has no other significant medical history.
The nurse has placed a nasogastric feeding tube to facilitate nutrition and medication administration and has ordered a portable abdominal radiograph to confirm its placement. The completed radiograph is shown. What is your impression?
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Answer The radiograph demonstrates a normal gas pattern with a properly placed enteric feeding tube, which appears to be within the stomach. Of note is a sclerotic-appearing lesion on the posterior aspect of the left eighth rib. In a patient with a possible tumor, this lesion poses concern for potential metastasis and warrants appropriate work-up.