Metastasis lytic ca breast LSBU

Description: Radiology case 4411-3310
The many medical students, to whom I have shown this, all fixate on the calcifications in the spleen. They then notice the calcification in the undersized left kidney and the mid-line calcifications. The absent right hemidiaphragm shadow or right mastectomy are noticed next. The right lower lobe shadowing and the calcification in the right costo-phrenic recess often push the thinking towards the blurred diaphragm margin. The right mastectomy deficit is usually noted next.
Practically all students had to view the film from the door to see the subtle difference in the ilia, where the wide zone of transition between normal and abnormal bone reduces the visibility of the destructive process in the lateral portion of ilium and iliac crest. Its inner extension is camouflaged by gas and faeces in the caecum, which overlie the zone of transition, which is just lateral to the right ala of sacrum, below the iliac crest. This zone is also visible immediately above the right acetabulum.