Metastatic breast cancer

Moderate sigmoid diverticulosis, scattered diverticula elsewhere. No significant colonic mass lesion/polyps demonstrated.

Multiple obstructing right pelvic calculi, largest measures 19 mm in diameter.

Marked thinning of the right renal cortex with severe hydronephrosis, suggesting long-standing obstruction. Multiple further nonobstructing right caliceal calculi.

Left renal cysts. Focus of left renal cortical calcification at point of thinning, possibly previous infarct. No obstructing calculi on the left.

Normal appearances of the unenhanced liver, gallbladder, adrenals, pancreas and spleen (tiny focus of calcification at periphery of spleen is of doubtful significance).

No size significant abdominal or pelvic nodal enlargement.

No free abdominal or pelvic fluid.

No adnexal mass.

Small right pleural effusion with multiple bilateral lower lobe and right perifissural nodules.

Area of asymmetric soft-tissue density in the left breast up to 40mm length extending to the skin surface superolateral to the nipple, impression of skin indrawing at this site.

Wedge compression fractures of T12, L1-L3.

Mottled appearance of T12 and L3 vertebral bodies with areas of cortical thinning, most noticeable at the posterior cortex of T12 .

Heterogeneous appearance of the right inferior pubic ramus close to the pubic symphysis with foci of cortical thinning (compared to the normal left superior pubic ramus).

Old right seventh posterolateral rib fracture, partially-imaged, though impression of mottled appearance at this site as well. Wide necked right lumber abdominal wall defect/hernia contains a segment of the ascending colon. Moderate size hiatus hernia.

Comments:

Sigmoid diverticulosis, no other significant colonic abnormality.

Asymmetric left breast changes extending to the skin surface with possible skin tethering - malignancy at this site requires exclusion. Urgent breast clinic referral advised.

Multiple vertebral wedge compression fractures, other sites of heterogeneous sclerotic/lytic bony changes as described appearances could be metabolic osteodystrophy but bony metastases is not excluded (particularly in the context of the Indeterminate breast lesion).

Small right pleural effusion and bibasal lung nodules, appearances more suggestive of inflammatory/infective nodules though malignancy not excluded.

Background breast tissue is fatty mixed density breast parenchyma.

Within the left breast at the site of patient's palpable lump within the left upper outer quadrant there is a 33 mm malignant mass. Second clinical image towards the left axillary tail is not completely covered on routine imaging however identified on repeat left MLO. No suspicious microcalcification within the left breast.

R-5 Left breast

Ultrasound scan performed between the left 12 to 3 o'clock sector including the patient's palpable lump within the left 2 o'clock sector 30 mm malignant mass.

At this site of clinical concern towards the left axillary tail/lateral left 1-2 o'clock sector 16 mm malignant mass.

Left breast R-5 multifocal left breast cancer.

A 28mm mass in the upper outer quadrant of the left breast corresponds to the mass seen on ultrasound.

A 17mm mass containing a marker clip at the left axillary tail/axilla corresponds to the second biopsy proven malignant mass/node. Further 5 mm left sub-pectoral lymph node and bilateral mediastinal lymphadenopathy (the largest centrally necrotic lymph node measures 13 mm in the right lower paratracheal region). Several rounded suspicious supraclavicular lymph nodes. Prominent lymph nodes in the right anterior pericardiac fat. No internal mammary or right axillary lymphadenopathy.

Moderate right-sided pleural effusion which has slightly increased in size. There is pleural thickening, pleural hyperenhancement (particularly the posterior upper lobe pleura) and nodularity involving both the mediastinal and costal pleura. No calcified pleural plaques to suggest previous asbestos exposure. Small pericardial effusion. Bilateral pulmonary nodules concerning for metastases.

Old right-sided rib fracture. Mixed lytic sclerotic changes throughout the spine concerning for metastases.

Conclusion: Overall appearances concerning for metastatic left breast carcinoma. The presence of dual pathologies (primary right pleural and left breast malignancies) is a possibility but felt less likely especially given the absence of calcified pleural plaques.