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Figure 4a.   Osteophyte of the left first rib in a 60-year-old woman. (a) Posteroanterior chest radiograph shows a poorly defined nodular area of increased opacity overlying the anterior aspect of the left first rib (arrow). (b) Posteroanterior chest radiograph obtained 2 years earlier shows that interval growth has occurred (cf a). This interval growth raised suspicion for malignancy. (c) Contiguous chest CT scans (image on right obtained at a lower level) reveal that the area of increased opacity is a large osteophyte of the first rib. Had fluoroscopy been performed, costly CT could have been avoided.