Imaging the treated breast presents challenges because of its limited compressibility and the overlapping features of benign posttreatment alterations and tumor recurrence. After lumpectomy and radiation therapy, mammographic findings such as breast edema, skin thickening, fluid collections, architectural distortion, and calcifications have characteristic sequences of evolution toward stability. Awareness of these normal chronologic imaging findings for the conservatively treated breast minimizes unnecessary recall from screening and permits early detection of recurrent breast carcinoma.
Imaging the treated breast presents challenges because of its limited compressibility and overlapping features of benign posttreatment alterations and tumor recurrence. After lumpectomy and radiation therapy, mammographic findings such as breast edema, skin thickening, fluid collections, architectural distortion, and calcifications have characteristic sequences of evolution toward stability. Changes in the imaging appearance after stability has been achieved--including increasing asymmetry, an enlarging mass, increasing edema or skin thickening, and the development of pleomorphic calcifications within or near the operative bed--should alert the radiologist to possible tumor recurrence. When mammography or sonography is indeterminate, MRI may be useful in excluding recurrence or providing a means for biopsy of a suspicious finding.
Non-cardiac thoracic manifestations of rheumatoid arthritis (RA) cause significant morbidity and mortality among RA patients. Essentially all anatomic compartments in the chest can be affected including the pleura, pulmonary parenchyma, airway, and vasculature. In addition, treatment-related complications and opportunistic infections are not uncommon. Accurate diagnosis of intra-thoracic disease in an RA patient can be difficult as the radiologic findings may be nonspecific and many of these conditions may coexist. This review article serves to highlight the multitude of RA-related intra-thoracic pathological processes, emphasize differential diagnosis, diagnostic conundrums and discuss how tailoring of CT imaging and image-guided biopsy plays a key role in the management of RA-related pulmonary disease.
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