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Rib metastasis - exam film

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Left shoulder pain. No trauma. No prior history of malignancy.

Patient Data

Age: 65 years
Gender: Female
x-ray

Lucency and cortical destruction of the left 5th rib.

The shoulder is normal in appearance.

Lungs clear.

A CXR sometime later

x-ray

Lucency and destruction of the left 5th rib.

Heart size normal.

Lungs clear.

Case Discussion

This is a classic exam film and also one which either gives us either delight or angst depending on if one spotted or missed this finding.

It is a so called 'edge case' with the findings being on the film, but not part of the anatomy chiefly being interrogated.

It teaches us the need to review the whole film.

The lesion is more advance and apparent on the subsequent chest x-ray, however this also could potentially be missed with a heavy workload, reporting at speed.

This was the patient's presenting complain and film for what subsequently turned out to be metastatic breast cancer.

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