Dear Friends,
Today’s images are a routine annual control of a 55-year-old woman operated on for carcinoma of the breast five years ago. What do you see?
Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.
Click here for the answer
Findings: an extrapulmonary lesion is visible in the lateral aspect of the right hemithorax in the PA radiograph (A-B, arrows). The lateral view is unremarkable. The lesion was not present in images taken one year earlier. Although it has been mentioned by one of you, I do not see any rib fractures. When I saw the images, my first impression was a metastatic pleural implant.
Unenhanced CT two weeks later shows healing fractures of the 5th and 6th ribs (C-E, arrows). The lesion has disappeared.
Final diagnosis: unsuspected rib fractures with extrapleural haematoma.
Congratulations to Maria P. who was the first to mention the right diagnosis.
Teaching point: I will repeat my advice of a recent similar case (Caceres’ corner161), which I promptly forgot and made an ass of myself! Rib fractures are common and should always be considered even if the findings are not clear.
