Findings

RADIOLOGY: A chest X-ray shows a diffuse mottled appearance to bones of left shoulder girdle with areas of osteopenia intermixed with sclerotic regions. There are mid-thoracic lateral rib fractures with reparative bone (arrow). Stigmata of breast cancer surgery and osseous changes confined to a typical breast cancer radiation treatment field.

SCINTIGRAPHY: Bone scintigraphy with Tc-99m MDP shows moderate focal increased uptake at the site of rib fractures. There is normal or very mild diffuse increased activity in the remainder of shoulder girdle. The exam is not significantly different from a prior bone scan 18 months earlier.

DIAGNOSIS: Osteoradionecrosis of the left shoulder girdle with lateral rib insufficiency fractures, probably with non-union. No evidence of metastatic recurrence.

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J. Anthony Parker, MD PhD, jap@nucmed.bih.harvard.edu