0:01

So let's just finish up with our last case here.

0:04

This patient here.

0:05

This...

0:06

History on this lady is that she's

0:08

a 36-year-old woman, newly diagnosed inflammatory breast cancer.

0:11

So you'll get another look at inflammatory breast cancer.

0:14

And again,

0:16

looking at the diffuse skin thickening and marked diffuse enhancement,

0:23

and I think we'll start with the gadolinium-enhanced stage.

0:30

I'll scroll through this while we...

0:32

it does its thing.

0:34

And what I want you to look at is the chest wall.

0:38

Okay?

0:39

This is our comparative case to the other one, looking at the chest wall, so.

0:44

We want to look at pectoralis, and we want to look at the chest wall in this case.

0:58

Let me window that up a little bit more

1:07

So, up at the top here.

1:16

And then I'm just going to show you, on her...

1:19

This is her subtraction image.

1:22

And I can show you the sagittal as well.

1:33

And sagittal image,

1:36

and the sagittals are really helpful I found for looking for chest wall invasion.

1:45

This is a sagittal recon.

1:46

For some reason, the original sagittal has vanished off packs.

1:57

And that shows it. All right, let's have the question.

2:06

You see, she got a ton of nodes up

2:08

in the axilla, really ugly looking.

2:10

Not a good cancer.

2:18

Everybody got it. All the four people who managed to hang on till the end

2:21

got it.

2:21

So what we're seeing here is this really

2:24

extensive enhancement going all the way through the chest wall.

2:28

You can see the enhancement in the skin here in the posterior breast tissue,

2:32

but then it's going through pectoralis

2:35

and it's in to the intercostal musculature itself.

2:40

The...

2:40

Let me show you on the...

2:48

And we can see a big chunky met sitting right here.

2:53

So this one is chest-wall invasion.

2:54

So you can have abutting pectoralis, invading pectoralis, or through pectoralis

2:59

and into the intercostal, which makes it inoperable.

3:03

Okay, so those to all my cases.

3:05

I'm sorry, I did run over a little bit.

3:08

All right. Well, thank you everybody for attending.

3:10

Thank you for the people who hung in till the end.

3:12

You are good souls.

3:14

And I hope to speak to you again some other session.