Cáceres’ Corner Case 219 – SOLVED!

Dear Friends,
Today’s images belong to a 67-year-old woman with pain in the chest.
What do you see?

More images will be presented next Wednesday and the answer will be published on Friday, as usual.

Click here to see more images

Dear Friends,

Showing additional axial CT images of the patient.
What do you see?

Click here for the solution

Findings: PA chest radiograph shows a lytic lesion of the 3rd right rib, accompanied by an extrapulmonary sign (A, circle). Lateral view (not shown) is unremarkable.

The lesion is more obvious in the cone-down view (B, circle), specially when compared to a previous study (C, circle).

Axial CT confirms a permeative lesion of the rib (D-E, arrows), as well as lytic lesion in the posterior elements of the 4th thoracic vertebra (E, red arrow). A serendipitous finding is a nodule in the medial quadrant of the left breast (F, arrow), demonstrated in a subsequent mammography (G, arrow) and confirmed to be a carcinoma.

Final diagnosis: carcinoma of the breast with osseous metastases
 
Congratulations to Diogo who saw and described the rib lesion in the plain film.
 
Teaching point:remember that our most common error is missing obvious lesions.
Checklists help to correct oversights. I believe the rib lesion could have been found if you had applied the checklist recommended in webinar one (H).

15 thoughts on “Cáceres’ Corner Case 219 – SOLVED!

  1. Fusiform dilatation of the aorta with deviation to the left side suggustive of aortic aneurysm however aortic dissection should be ruled out for clinical correlation

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  2. There’s an expansily lytic lesion in the 3rd right rib and probably a pathologic fracture. At this age, i’d be concerned about a metastasis (RCC, breast) and multiple myeloma/plasmocytoma.

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  3. Good afternoon!!

    There is a double aortic contour in descending aorta, so disection must be rule out. Fracture of the right third costal arc

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  4. Abnormal shadow of thedescending aorta more displaced with unclassic course mildly dilated high possibility of aneurysm, dissection to be excluded

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  5. Good evening professor

    Radiograph showing deviation of left paraspinal line

    An enhancing irregular lesion in the left anterior chest -malignant mass in breast

    Multiple lytic lesion in? D4 thoracic vertebrae and posterolateral aspect of third rib

    Like

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