11Thorax

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F: No fracture, no effusion, no pneumothorax. But notize the increased transparency of the thorax at the right side. There are also two round structures in the right lung and one at the left lung. There is also a osteolytic lesion at the forth left-sided rib.

H: Adult woman, 52-years-old, admitted after road traffic accident. The patient mentions multiple fractures of the distal extremities in the past.

INFO/WWW: The mentioned fractures were pathologic fractures caused by metastases. Primary tumours e.g. breast cancer, bronchial carcinoma, carcinoma of the kidney or thyroid usually metastazise to the skeleton, especially the axial skeleton and cause lytic lesions in the bone. Whereas sclerotic lesions are usually caused by prostatic carcinoma.Those tumours which disseminate to the distal extremities usually arise from the bronchus or the breast.
Other causes of pathologic fractures are e.g. at an early age osteogenis imperfecta, rickets or osteomalacia (either intestinal or renal tubular disorders). Always consider Cushing`s syndrome, hyperparathyroidism and after the menopause osteoporosis.

D: Mastectomy at the right side - after carcinoma of the right breast. Secondaries in the right and left lung and in the forth left rib

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