J Korean Soc Radiol.  2019 Sep;80(5):1003-1007. 10.3348/jksr.2019.80.5.1003.

Osteoradionecrosis of the Anterior Thoracic Wall after Radiation Therapy for Breast Cancer

• Kim YS
• Yoon JH

• KMID: 2459029
• DOI: http://doi.org/10.3348/jksr.2019.80.5.1003

Abstract

Although osteoradionecrosis of the thoracic wall is rare, severe complications following radiation therapy for breast cancer can occur. The authors report the case of a 65-year-old woman who developed osteoradionecrosis in the left thoracic wall 17 years after undergoing radiation therapy for breast cancer. Chest CT revealed fractures in the left third and fourth ribs as well as in the sternal body, with severe sclerotic and lytic changes and cortical irregularity. Ultrasonography of the left chest wall revealed diffuse edematous changes in the overlying skin layer. Radiologists should be familiar with the imaging findings of osteoradionecrosis to differentiate osteoradionecrosis from bony metastasis.

MeSH Terms

Aged
Breast Neoplasms*
Breast*
Female
Humans
Neoplasm Metastasis
Osteoradionecrosis*
Radiotherapy
Ribs
Skin
Thoracic Wall*
Tomography, X-Ray Computed
Ultrasonography

Figure

• 

  Fig. 1 Radiologic findings of osteoradionecrosis of the ribs and sternum after radiation therapy for breast cancer in a 65-year-old woman. A. CT of the chest wall revealing fractures with sclerotic change and cortical irregularity of left third and fourth ribs, and sternal body (arrows). Ulceration at overlying skin layer is also noted (arrowhead). B. Ultrasonography of the left chest wall reveals diffuse thickening of skin (arrows) and edematous change of subcutaneous fat layer. C. PET/CT demonstrating increased uptake of radioisotope in the sternal body and left ribs, and surrounding soft tissue (arrows). D. Two years later, follow-up PET/CT demonstrating continued hot uptake in the sternal body and left ribs, with progressed sclerotic changes and non-union state of rib fractures (arrows).

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