Case History

A 65-year-old woman presents for MRI with a new palpable right chest wall mass and shoulder pain for 4 months. She has had a right modified mastectomy for breast cancer 17 years prior to this examination. Her axillary dissection revealed 3 of 17 nodes with metastatic tumor. She is also status post–right total shoulder arthroplasty 4 years prior to exam. MRI demonstrates a chest wall mass, so mammograms, right breast sonogram, and positron emission tomography–computed tomography (PET-CT) are performed.

Physical Examination

• Patient has a hard right chest wall mass.

Fig. 37.1 Right axillary mammogram. There is an ill-defined, irregular mass (arrow) in the axilla.

Fig. 37.2 Right chest sonogram. The palpable chest wall mass corresponds to a heavily shadowing, spiculated, hypoechoic solid mass.

Fig. 37.3 Contrast-enhanced bilateral breast MRI maximum projection intensity (MIP) image. There is an irregular right chest wall mass (arrow) that exhibits rapid enhancement and washout.

Fig. 37.4 Axial positron emission tomography–computed tomography (PET-CT). There is ¹⁸F-fluorodeoxyglucose (FDG) uptake in the chest wall mass (arrow) that invades the pectoralis muscle. This exam also shows abnormal uptake in the right axillary nodes (A).

Fig. 37.5