Breast cancer metastasis to distal clavicle - pathological fracture

Case contributed by Alexandra Stanislavsky
Diagnosis almost certain


No clinical history provided.

Patient Data

Age: 35 years
Gender: Female

Minimally displaced fracture through the distal third of the clavicle, at or just lateral to the coracoclavicular ligaments. The underlying bone appears abnormal and lucent, with a wide zone of transition and periosteal reaction is already visible.  

A relatively large segment of clavicle (yellow dotted lines) is lucent with irregular margins and a wide zone of transition. Periosteal reaction can already be seen (blue arrows) superiorly, which is strong evidence that this there is a non-acute process present. 

Unfortunately, the subtle hypodensity and periosteal reaction surrounding the fracture site were not appreciated when the patient was seen in the emergency department of another hospital and the patient was treated conservatively, until she represented with ongoing pain and an increasingly large swelling in the region. 

2 mth later - persistent pain


Follow up radiograph obtained 2 months later demonstrates an obviously aggressive lesion with a soft tissue component destroying the outer third of the clavicle. The acromium and coracoid appear intact. No other destructive lesions are evident. 

Case Discussion

Further bony/soft tissue metastases in pelvis and liver metastases were identified (not shown). Biopsy suggestive of a breast primary, although no breast lesion was found at the time.  

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