Young Girl With Shoulder and Chest Pain Bruno Passebon Soares, MD, Eleza T. Golden, MD  Annals of Emergency Medicine  Volume 67, Issue 5, (May 2016) DOI: 10.1016/j.annemergmed.2015.11.017 Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 1 Frontal radiograph of the right shoulder, showing linear opacities (arrow) projecting over the right lung apex and neck, corresponding to a pencil with central lead. Annals of Emergency Medicine 2016 67, DOI: (10.1016/j.annemergmed.2015.11.017) Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 2 CT angiography 3-dimensional reformatting of the neck, demonstrating anterior oblique view of a pencil coursing inferior to the right clavicle and subclavian artery, between the first and second ribs (arrow), with the separated tip of the pencil located lateral to the bifurcation of the right common carotid artery (arrowhead). Annals of Emergency Medicine 2016 67, DOI: (10.1016/j.annemergmed.2015.11.017) Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 3 Axial CT angiography image through the lung apices, showing the pencil coursing inferior to the right clavicle between the first and second ribs (arrow), with a small fissure-contained lung contusion in the azygous lobe (arrowhead). Annals of Emergency Medicine 2016 67, DOI: (10.1016/j.annemergmed.2015.11.017) Copyright © 2016 American College of Emergency Physicians Terms and Conditions