Pleural metastases from carcinoma of the breast.

HISTORY: Right upper quadrant pain in a 62-year-old female with known breast carcinoma.

FINDINGS: Images 1-4 are intercostal scans of the dome of the liver and

right pleural space obtained with the patient in an upright position.

Note that there is hypoechoic pleural fluid as well as echogenic tissue

(arrow, Image 1) within the pleural space.  Image 4 is a spectral

Doppler tracing demonstrating arterial flow from the echogenic pleural

mass.

 

DIAGNOSIS: Pleural metastases from carcinoma of the breast.

DISCUSSION: Pleuritic pain (as in this patient) may at times be

clinically mistaken for abdominal pathology such as acute cholecystitis,

liver abscess, etc.  The echogenic pleural based tissue demonstrated

arterial flow on color Doppler.  This finding strongly suggested pleural

based metastases.  The differential diagnosis includes primary pleural

tumor such as mesothelioma as well as metastases.  Hemothorax or empyema

within the pleural space is avascular with color Doppler.