DOI: 10.1148/rg.245035062
Thoracic Manifestations of Breast Cancer and Its Therapy1
Jung Im Jung, MD,
Hak Hee Kim, MD,
Seog Hee Park, MD,
Sun Wha Song, MD,
Myeong Hee Chung, MD,
Hyeon Sook Kim, MD,
Ki Jun Kim, MD,
Myeong Im Ahn, MD,
Soon Beom Seo, MD and
Seong Tai Hahn, MD
1 From the Department of Radiology, St Mary’s Hospital, College of Medicine, Catholic University of Korea, 62 Yeouido-dong, Youngdungpo-gu, Seoul 150–713, South Korea (J.I.J., S.H.P., S.W.S., M.H.C., H.S.K., K.J.K., M.I.A., S.T.H.); and the Department of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea (H.H.K., S.B.S.). Presented as an education exhibit at the 2002 RSNA scientific assembly. Received March 13, 2003; revision requested June 3 and final revision received December 19; accepted December 23. All authors have no financial relationships to disclose. Address correspondence to J.I.J. (e-mail: jijung@catholic.ac.kr).
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Figure 1. Right radical mastectomy. Computed tomographic (CT) scan demonstrates absence of the pectoralis major (*) and pectoralis minor ( ) muscles on the right side.
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Figure 2a. Right-sided modified Patey procedure. CT scans demonstrate absence of the pectoralis minor muscle ( in a) and atrophy of the pectoralis major muscle (arrows in b) on the right side. Note also the metastatic pleural masses on the right side.
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Figure 2b. Right-sided modified Patey procedure. CT scans demonstrate absence of the pectoralis minor muscle ( in a) and atrophy of the pectoralis major muscle (arrows in b) on the right side. Note also the metastatic pleural masses on the right side.
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Figure 3. Left-sided Auchincloss procedure. CT scan shows intact pectoralis major (*) and pectoralis minor () muscles at the mastectomy site.
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Figure 4a. Left-sided BCS. CT scans show volume loss of glandular tissue and adjacent linear strands at the lumpectomy site (arrow in a) and loss of soft tissue at the left axillary node dissection site (arrow in b).
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Figure 4b. Left-sided BCS. CT scans show volume loss of glandular tissue and adjacent linear strands at the lumpectomy site (arrow in a) and loss of soft tissue at the left axillary node dissection site (arrow in b).
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Figure 5. TRAM flap reconstruction of the right breast after MRM for breast cancer in a 38-year-old woman. CT scan shows the breast with fat attenuation. Note the thin, curvilinear soft-tissue band (arrows), which represents skin from the abdominal wall.
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Figure 6a. Seroma in a 43-year-old woman who had undergone BCS 2 months earlier. (a) CT scan shows a well-defined, ovoid, low-attenuation mass at the surgery site. (b) US image reveals that the lesion is an anechoic fluid collection. Clear, yellowish fluid was aspirated.
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Figure 6b. Seroma in a 43-year-old woman who had undergone BCS 2 months earlier. (a) CT scan shows a well-defined, ovoid, low-attenuation mass at the surgery site. (b) US image reveals that the lesion is an anechoic fluid collection. Clear, yellowish fluid was aspirated.
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Figure 7. Right breast cancer in a 59-year-old woman who had undergone BCS 1 month earlier. The patient complained of swelling, with local heat and redness of the surgical wound. Contrast material-enhanced CT scan shows a low-attenuation fluid collection with an air-fluid level and diffuse, thick wall enhancement. S aureus was seen in the culture of the aspirated pus specimen.
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Figure 8a. Left breast cancer in a 31-year-old woman who had undergone BCS and irradiation. (a) Portal radiograph demonstrates a tangential beam radiation field. (b) Radiograph obtained 4 months after completion of radiation therapy shows ill-defined haziness in the lateral part of the left midlung (arrow). (c) CT scan obtained 4 months after the radiograph in b demonstrates consolidation with a sharp posterior margin peripherally in the left upper lobe (arrows) that conforms to the shape of the tangential beam radiation field.
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Figure 8b. Left breast cancer in a 31-year-old woman who had undergone BCS and irradiation. (a) Portal radiograph demonstrates a tangential beam radiation field. (b) Radiograph obtained 4 months after completion of radiation therapy shows ill-defined haziness in the lateral part of the left midlung (arrow). (c) CT scan obtained 4 months after the radiograph in b demonstrates consolidation with a sharp posterior margin peripherally in the left upper lobe (arrows) that conforms to the shape of the tangential beam radiation field.
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Figure 8c. Left breast cancer in a 31-year-old woman who had undergone BCS and irradiation. (a) Portal radiograph demonstrates a tangential beam radiation field. (b) Radiograph obtained 4 months after completion of radiation therapy shows ill-defined haziness in the lateral part of the left midlung (arrow). (c) CT scan obtained 4 months after the radiograph in b demonstrates consolidation with a sharp posterior margin peripherally in the left upper lobe (arrows) that conforms to the shape of the tangential beam radiation field.
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Figure 9a. Left breast cancer in a 66-year-old woman who had undergone MRM and irradiation. (a) Portal radiograph demonstrates a supraclavicular field. (b) Radiograph obtained 4 months following completion of radiation therapy shows ill-defined consolidation in the left apex (arrows). (c) CT scan shows ill-defined patchy consolidations in the left apex. (d) Follow-up chest radiograph shows some linear areas of increased opacity in the left apex (arrow), a finding that mimics tuberculous scar. (e) CT scan obtained 15 months later shows regression of the areas of increased opacity in d into a dense, bandlike fibrosis.
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Figure 9b. Left breast cancer in a 66-year-old woman who had undergone MRM and irradiation. (a) Portal radiograph demonstrates a supraclavicular field. (b) Radiograph obtained 4 months following completion of radiation therapy shows ill-defined consolidation in the left apex (arrows). (c) CT scan shows ill-defined patchy consolidations in the left apex. (d) Follow-up chest radiograph shows some linear areas of increased opacity in the left apex (arrow), a finding that mimics tuberculous scar. (e) CT scan obtained 15 months later shows regression of the areas of increased opacity in d into a dense, bandlike fibrosis.
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Figure 9c. Left breast cancer in a 66-year-old woman who had undergone MRM and irradiation. (a) Portal radiograph demonstrates a supraclavicular field. (b) Radiograph obtained 4 months following completion of radiation therapy shows ill-defined consolidation in the left apex (arrows). (c) CT scan shows ill-defined patchy consolidations in the left apex. (d) Follow-up chest radiograph shows some linear areas of increased opacity in the left apex (arrow), a finding that mimics tuberculous scar. (e) CT scan obtained 15 months later shows regression of the areas of increased opacity in d into a dense, bandlike fibrosis.
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Figure 9d. Left breast cancer in a 66-year-old woman who had undergone MRM and irradiation. (a) Portal radiograph demonstrates a supraclavicular field. (b) Radiograph obtained 4 months following completion of radiation therapy shows ill-defined consolidation in the left apex (arrows). (c) CT scan shows ill-defined patchy consolidations in the left apex. (d) Follow-up chest radiograph shows some linear areas of increased opacity in the left apex (arrow), a finding that mimics tuberculous scar. (e) CT scan obtained 15 months later shows regression of the areas of increased opacity in d into a dense, bandlike fibrosis.
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Figure 9e. Left breast cancer in a 66-year-old woman who had undergone MRM and irradiation. (a) Portal radiograph demonstrates a supraclavicular field. (b) Radiograph obtained 4 months following completion of radiation therapy shows ill-defined consolidation in the left apex (arrows). (c) CT scan shows ill-defined patchy consolidations in the left apex. (d) Follow-up chest radiograph shows some linear areas of increased opacity in the left apex (arrow), a finding that mimics tuberculous scar. (e) CT scan obtained 15 months later shows regression of the areas of increased opacity in d into a dense, bandlike fibrosis.
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Figure 10a. Recurrent breast cancer in the chest wall in a 39-year-old woman who had undergone MRM. (a) Chest radiograph obtained 3 months following completion of radiation therapy shows ill-defined consolidations in the medial portion of the right lung that conform to the internal mammary field. (b) Follow-up chest radiograph obtained 1 month later shows resolution of the pneumonia and some residual linear areas of increased opacity.
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Figure 10b. Recurrent breast cancer in the chest wall in a 39-year-old woman who had undergone MRM. (a) Chest radiograph obtained 3 months following completion of radiation therapy shows ill-defined consolidations in the medial portion of the right lung that conform to the internal mammary field. (b) Follow-up chest radiograph obtained 1 month later shows resolution of the pneumonia and some residual linear areas of increased opacity.
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Figure 11a. Doxorubicin-induced cardiotoxicity in a 46-year-old woman who had undergone left MRM and adjuvant chemotherapy that included four cycles of doxorubicin. (a) Chest radiograph shows enlargement of the cardiac silhouette. (b) Chest CT scan shows global enlargement of the cardiac chambers and a small amount of pericardial effusion (arrows). Echocardiography demonstrated a decreased LV ejection fraction (25%) with severe LV dysfunction and LV dilatation, as well as enlargement of both atria. The total cumulative dose of doxorubicin was 360 mg/m2.
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Figure 11b. Doxorubicin-induced cardiotoxicity in a 46-year-old woman who had undergone left MRM and adjuvant chemotherapy that included four cycles of doxorubicin. (a) Chest radiograph shows enlargement of the cardiac silhouette. (b) Chest CT scan shows global enlargement of the cardiac chambers and a small amount of pericardial effusion (arrows). Echocardiography demonstrated a decreased LV ejection fraction (25%) with severe LV dysfunction and LV dilatation, as well as enlargement of both atria. The total cumulative dose of doxorubicin was 360 mg/m2.
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Figure 12a. Pneumonia in a 46-year-old woman with breast cancer who had undergone high-dose chemotherapy and autologous bone marrow transplantation. (a) Chest radiograph shows ill-defined consolidation in the right cardiophrenic angle. (b) CT scan shows a triangular enhancing consolidation with round, well-defined, low-attenuation necrosis in the right middle lobe, findings that suggest pneumonia with abscess formation. The white blood cell count was 1200/mm3. The causative organism was not identified. (c) Radiograph obtained after empirical treatment with antibiotics shows complete resolution of the pneumonia.
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Figure 12b. Pneumonia in a 46-year-old woman with breast cancer who had undergone high-dose chemotherapy and autologous bone marrow transplantation. (a) Chest radiograph shows ill-defined consolidation in the right cardiophrenic angle. (b) CT scan shows a triangular enhancing consolidation with round, well-defined, low-attenuation necrosis in the right middle lobe, findings that suggest pneumonia with abscess formation. The white blood cell count was 1200/mm3. The causative organism was not identified. (c) Radiograph obtained after empirical treatment with antibiotics shows complete resolution of the pneumonia.
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Figure 12c. Pneumonia in a 46-year-old woman with breast cancer who had undergone high-dose chemotherapy and autologous bone marrow transplantation. (a) Chest radiograph shows ill-defined consolidation in the right cardiophrenic angle. (b) CT scan shows a triangular enhancing consolidation with round, well-defined, low-attenuation necrosis in the right middle lobe, findings that suggest pneumonia with abscess formation. The white blood cell count was 1200/mm3. The causative organism was not identified. (c) Radiograph obtained after empirical treatment with antibiotics shows complete resolution of the pneumonia.
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Figure 13a. Local recurrence in a 55-year-old woman who had undergone MRM and irradiation 2 years earlier. (a) Chest CT scan shows a 1.5-cm enhancing nodule in the right pectoralis major muscle at the mastectomy site (arrow). (b) US image shows an irregular hypoechoic nodule (arrows). The mass was not palpated at physical examination.
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Figure 13b. Local recurrence in a 55-year-old woman who had undergone MRM and irradiation 2 years earlier. (a) Chest CT scan shows a 1.5-cm enhancing nodule in the right pectoralis major muscle at the mastectomy site (arrow). (b) US image shows an irregular hypoechoic nodule (arrows). The mass was not palpated at physical examination.
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Figure 14. Residual pectoralis muscle mimicking local recurrence in a 54-year-old woman who had undergone radical mastectomy. CT scan shows a residual pectoralis muscle (arrow). Note the small effusion in the dependent portion of the right side of the thorax, which proved to be reactive fluid.
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Figure 15. Chest wall recurrence in a 44-year-old woman who had undergone left MRM. CT scan shows chest wall recurrence (short arrows) in contiguity with right internal mammary lymph node metastasis (long arrow).
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Figure 16. Mediastinal lymph node metastasis in a 63-year-old woman who had undergone left MRM. CT scan shows enlarged lymph nodes in the anterior mediastinum in contiguity with internal mammary lymph nodes.
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Figure 17a. Bone metastasis in a 36-year-old woman with breast cancer. (a) Chest radiograph shows sclerosis of the ribs, clavicles, and vertebral bodies. (b) 99mTc methylene diphosphonate-labeled bone scintigram shows pronounced skeletal uptake and absent renal activity (superscan).
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Figure 17b. Bone metastasis in a 36-year-old woman with breast cancer. (a) Chest radiograph shows sclerosis of the ribs, clavicles, and vertebral bodies. (b) 99mTc methylene diphosphonate-labeled bone scintigram shows pronounced skeletal uptake and absent renal activity (superscan).
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Figure 18. Spinal cord compression from bone metastasis in a 55-year-old woman with breast cancer. Chest CT scan shows bone metastasis to the thoracic vertebrae manifesting as an epidural mass that compresses the spinal cord.
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Figure 19. Solitary metastatic nodule in a 34-year-old woman who had undergone BCS 25 months earlier. Precontrast CT scan shows a solitary pulmonary nodule in the lingular segment of the left upper lobe. Wedge resection of the nodule revealed metastatic breast cancer.
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Figure 20. Multiple metastatic nodules in a 46-year-old woman with breast cancer. CT scan shows multiple round metastatic nodules. Note the cavitation of two of the nodules (arrows).
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Figure 21. Airspace pattern metastasis in a 55-year-old woman. Contrast-enhanced CT scan shows lobar consolidation with an air bronchogram of the left lower lobe (arrow) mimicking pneumonia. Biopsy revealed a metastatic tumor from breast cancer.
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Figure 22. Lymphangitic metastasis in a 47-year-old woman with breast cancer. High-resolution CT scan shows nodular thickening of the interlobular septa with prominent centrilobular structures.
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Figure 23. Endobronchial metastasis in a 47-year-old woman who had undergone left MRM. CT scan shows a lobulated endobronchial mass obstructing the left main bronchus (arrowhead), resulting in total collapse of the left lung. Pleural effusion is also seen (arrows), a finding that suggests pleural metastasis.
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Figure 24a. Pleural metastasis. (a) Chest CT scan obtained in a 43-year-old woman with right breast cancer who presented with dyspnea shows a large amount of right pleural effusion with mass effect and total collapse of the right lung. Note the thin, even enhancement of the parietal pleura. (b) Chest CT scan obtained in a 44-year-old woman who had undergone left MRM and mammoplasty shows left pleural effusion and irregular plaquelike pleural enhancement (arrows).
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Figure 24b. Pleural metastasis. (a) Chest CT scan obtained in a 43-year-old woman with right breast cancer who presented with dyspnea shows a large amount of right pleural effusion with mass effect and total collapse of the right lung. Note the thin, even enhancement of the parietal pleura. (b) Chest CT scan obtained in a 44-year-old woman who had undergone left MRM and mammoplasty shows left pleural effusion and irregular plaquelike pleural enhancement (arrows).
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Figure 25. Pericardial metastasis in a 34-year-old woman who had undergone MRM. CT scan shows pericardial enhancement (arrows). Pericardial effusion had been drained earlier, and cytologic analysis of the aspirate revealed metastasis. Note the pleural metastasis in the left side of the thorax.
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Copyright © 2004 by the Radiological Society of North America.
