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.


View main image(mi) in a separate image viewer

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.


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.


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


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)

Search for similar cases.

Edit this case

Add comments about this case

Read comments about this case

Return to the Teaching File home page.

Case number: mi002

Copyright by Wash U MO