Reason: Breast cancer: Pain in right shoulder: has metastasis in shoulder; looking for fracture/ tear. History: Breast cancer: Pain in right shoulder: has metastasis in shoulder; looking for fracture/tear Note is made of a lesion within the right humeral head and neck which extends to the level of the proximal humeral diaphysis and demonstrates increased signal abnormality on fluid sensitive sequences with enhancement on postcontrast sequences consistent with the findings of a lytic lesion seen on recent radiographs, likely representing osseous metastatic disease. This lesion spans the entire medullary space of the proximal humerus with associated multifocal cortical disruption along the inferomedial aspect of the humeral head as well as along the posterior and lateral aspect of the surgical neck of the humerus. There is enhancing soft tissue extension in the surrounding area. There is also a focus of enhancing bone marrow signal abnormality within the coracoid process indicating an additional focus of osseous metastatic disease. There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. No full-thickness rotator cuff tear is evident. There is a small amount of fluid within the subcoracoid bursa which may reflect a mild bursitis. There is a small amount of fluid within the glenohumeral joint which extends into the subscapular recess with associated enhancement on postcontrast sequences likely representing a synovitis.
Large focus of enhancing bone marrow signal abnormality in the proximal humerus consistent with the patient's known history of osseous metastatic disease. There is associated multifocal cortical destruction at the level of the surgical neck of the humerus as well as along the inferomedial aspect of the humeral head. An additional osseous metastatic deposit is identified within the coracoid.