Case Author(s): Thomas Vreeland, MD/ J. Wallis , 7/17/94 . Rating: #D2, #Q5
Diagnosis: Breast Carcinoma
Brief history:
This patient is a 54 year old woman being
evaluated with myocardial imaging as part of
preoperative assesment. The patient has a
remote history of a non-Q wave myocardial
infarct.
Images:
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Full history/Diagnosis is available below
Diagnosis: Breast Carcinoma
Full history:
This patient is a 54 year old woman with newly diagnosed
left-sided breast cancer, being evaluated preoperatively
before underoing a left-sided mastectomy. The patient has
remote history of a non-Q wave myocardial infarct.
Currently, the patient has no clinical
symptoms suggestive of ischemia.
Findings:
Myocardial Imaging;
(1) No evidence of ischemia. Apparent redistribution
in the lateral wall is most likely due to slight shift
in breast position.
(2) Two foci of markedly increased activity are noted.
The first foci is noted in the left breast (in the upper,
inner quadrant); the second foci of increased activity
involves the left axilla.
Discussion:
Thallium is utilized in the detection of tumors, such as
parathyroid adenomas and central nervous system tumors;
however, this case nicely demonstrates thallium's ability
to incidentally detect breast carcinoma and regional
lymph node metastasis. Recognition of the abnormal uptake
of thallium in the adjacent soft tissues on myocardial
imaging can occasionally assist in the detection of an
unsuspected primary or secondary tumor.
The markedly increased activity in the liver and
intestinal tract indicate pharmacologic (dipyridamole)
stress was employed
Followup:
The patient has undergone a left mastectomy
and has started chemotherapy.
Major teaching point(s):
(1) It is important to look at the entire image when
evaluating any nuclear medicine study or radiologic study.
(2) Utilization of different projections assisted in
localizing the abnormalities.
Differential Diagnosis List
(1) Tumor (Malignant or,less likely, benign)
(2) Inflamatory / Infectious etiologies
(3) Skin Contamination (unlikely in this case)
ACR Codes and Keywords:
References and General Discussion of Myocardial Imaging (Anatomic field:Breast, Category:Neoplasm, Neoplastic-like condition)
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Case number: mi002
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