Breast carcinoma with pathological hip fracture

Case contributed by Dr Ian Bickle

Presentation

Simple fall. Right hip fracture on radiograph. Believed to be pathological. Clinicians wishes to 'hunt the primary'.

Patient Data

Age: 65 years
Gender: Female
CT

CT chest, abdomen and pelvis

Chest:

8.2 cm irregular mass in the upper outer quadrant of the right breast, extending to the skin, which is thickened. Several smaller satellite nodules throughout the right breast.

Large volume right axillary lymphadenopathy up to 3.7 cm in short axis diameter.

5 mm right upper lobe lung nodule. Left basal atelectasis.

Abdomen:

Two subcentimetre lesions on the background of a fatty liver. These may be metastases.

Solid organs otherwise normal.

Bones:

T12 metastatic superior endplate wedge fracture.  Small lucent bone lesions in the pelvis.

Pathological fracture through the right neck of femur.

Comment:

1. Right breast malignancy with bone and lung metastases.

2. Pathological fracture of right femoral neck.

Comminuted fracture through a 3.8 cm lytic lesion in the right femoral neck.

Smaller lucent lesions in the visualised pelvis in keeping with metastases.

Comment: pathological right extracapsular fracture (likely breast primary).

Case Discussion

Right breast biopsy:  High-grade infiltrating duct carcinoma.

'Hunt the primary' is not an infrequent request for CT of the chest, abdomen and pelvis.  In this case due to a pathological hip fracture.

Perhaps the fact a radiologist was the first person to notice the huge breast primary with overlying skin thickening is a little depressing (it should be obvious on physical examination).

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Case information

rID: 60314
Published: 21st May 2018
Last edited: 22nd May 2018
Tag: ripas2
Inclusion in quiz mode: Included

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