CASE 18

Imaging Studies of the Chest

PANEL A:
A right pleural effusion was seen on multiple imaging studies over time
An axial fast spinecho T2-weighted MRI scan of the right breast:
o obtained with the patient in the prone position 14 years before the
current presentation:
o shows a right pleural effusion (arrow)in the anterior (dependent) right
hemithorax.

PANEL B:
An axial contrast-enhanced CT scan of the midthorax:
o shows persistence of the right pleural effusion (arrow)

PANEL C
There is no abnormal pleural enhancement or nodularity and no evidence
of cancer in the lungs.
Several subcentimeter pulmonary nodules (not shown) have long-term
stability (>5 years) and therefore are considered to be benign.
A radiograph of the chest, obtained with the patient in the right lateral
decubitus position during follow-up:
o shows continued persistence of the small right pleural effusion, which
is seen layering and extending into the minor fissure (arrow).

Imaging Studies of the Pelvis.

Axial and sagittal fast spinecho T2-weighted MRI scans of the pelvis (Panels A and
B, respectively) and axial threedimensional fat-saturated gradient-recalled echo
T1-weighted MRI scans of the pelvis, obtained before (Panel C) and after (Panel D)
the administration of extracellular gadolinium-based contrast material, are shown. A
pelvic mass measuring 9.9 cm in greatest dimension (Panels A through D, black
asterisks) is shown in contact with the right broad ligament (Panel A, black arrow).
The mass has a low signal on T2-weighted images (Panels A and B) and has
heterogeneous, low-level enhancement throughout, indicating that it is solid (Panel
D). There is no visible connection between the mass and the uterine corpus.
Additional findings include a moderate volume of free fluid (Panels A and B, white
arrows), a normal endometrium, a 3.6-cm intramural fibroid in the posterior uterine
body (Panels A through D, white asterisks), and a small simple cyst in the left ovary
(not shown); the right ovary is not identified.