Note the rib fracture. The same problem arises in other areas of radiology, such as mammography. The answer is to obtain, whenever possible, an orthogonal view. CT scan of the chest may be necessary when multiple nodules are involved. Radiographic findings are compatible with, but not specific for, the cutaneous manifestations of Neurofibromatosis.
Cutaneous nodules can simulate lung nodules.
These can metastasize to the lungs. Widened neural foramena and posterior scalloping, T-spine. Short segment, sharp angle scoliosis. Neurofibromatosis is a multi-organ disease. Neuro, GI, GU, and Bone radiology textbooks can be consulted for more information.