Dear Friends,
Muppet is getting old and feeble and, after more than one year of showing cases, is exhausted. He has decided to stop searching for exclusive cases and has decided to show only cases seen within the last two weeks. Hopes they are still worth presenting and will earn your approval. The first case, seen on April 15, is the PA chest radiograph of a 57-year-old woman with previous breast cancer, removed. What do you think of the anterior right fifth rib?
Diagnosis:
1. Metastases
2. Fibrous dysplasia
3. Paget’s disease
4. None of the above
57-year-old woman, PA chest
Click here for the answer to case #64
Findings: the PA radiograph shows increased density of the anterior aspect of the right 2nd and 6th ribs (arrows). There is collapse of T-8 and sclerosis of L-1 (
red arrows). These findings are highly suspicious of osteoblastic metastases, especially in a patient with breast carcinoma.
Sagittal and coronal CT confirms the widespread sclerotic changes of the spine, affecting the right scapula as well.
Final diagnosis: osteoblastic metastases from breast carcinoma
Congratulations to Katerina, who was the first to answer and gave the right diagnosis.
Teaching point: always consider a common manifestation of a common disease. In this particular case, Paget’s disease and fibrous dysplasia are a distant second choice
