Rib metastasis: unknown primary
Previously operated on for rib tumor.
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No significant right pleura effusion. CT demonstrates small non specific linear fibrosis and possibility of reflectory (Fleischner) atelectasis but no evidence of pulmonary nodules in the right lung.
Left pleura effusion posteriorly associated with irregular pleura thickening.
CT scan shows a large soft tissue masses involving V left posterior rib with mottled calcification and rib destruction. Involving masses spread and causes destruction of Th IV- V vertebra body and posterior elements with reactive sclerosis, also compress the spinal canal. Evidence of infiltration in left intercostal spaces and back muscles with low attenuation zones from cervical VII to thoracic VI vertebral level, possibly associated with postoperative changes. Hyperostosis of left IV and VI ribs.
Masses spread to pleura and compress lung parenchyma with possible invasion in lung tissue. Mass in left lung apicoposterior segment and left hilar lymph nodes consistent with metastases.
Abdominal CT with no significant changes.
Conclusion: findings suggest advanced primary osteosarcoma differentiated with chondrosarcoma or metastases, non typical of primary lung tumor.
74 year old foreign female, previously operated on for rib tumor. Biopsy reveals adenocarcinoma with positive estrogen receptors expression. Findings suggest primary breast or lung tumor with metastases in rib, vertebra, chest wall and back muscles.