case_images: PMC2938458_01
case_images: 46-year-old woman with pancreatic cancer and prior distal pancreatectomy. CT scan with contrast through the pancreas. There is calcification at the cut surface of the pancreas (white arrow). No residual tumor is seen at this site. Cholecystectomy clips are present in the gall bladder fossa (black arrow).
case_images: CRM2010-634975.001.jpg
case_images: PMC2938458_01_CRM2010-634975.001.jpg
case_images: fig1
case_images: African American woman who was initially diagnosed with pancreatic adenocarcinoma in spring of 2007. A CT scan of chest/abdomen/pelvis revealed no evidence of metastatic disease, including bones (Figure 1).
case_images: CT scan with contrast through the clavicle. There is increased sclerosis of the medial right clavicular head (white arrow) with a moth-eaten appearance of the cortex and medullary space. The differential diagnosis is metastasis or chronic osteomyelitis. Biopsy subsequently showed metastatic pancreatic cancer.
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case_images: PMC2938458_01_CRM2010-634975.002.jpg
case_images: fig2
case_images: A repeat CT scan showed increased sclerosis of the medial right clavicular head (Figure 2) with a moth-eaten appearance of the cortex and medullary space.
case_images: Frontal projection from a bone scan shows increased tracer uptake in the medial right clavicle, consistent with either metastatic disease or osteomyelitis. Biopsy confirmed metastatic pancreatic cancer.
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case_images: PMC2938458_01_CRM2010-634975.003.jpg
case_images: fig3
case_images: This was followed by a PET scan that showed increased tracer uptake in the medial right clavicle, consistent with either metastatic disease or osteomyelitis (Figure 3).
case_images: Histological findings of the clavicle biopsy showing metastases pancreatic cancer.
case_images: CRM2010-634975.004.jpg
case_images: PMC2938458_01_CRM2010-634975.004.jpg
case_images: fig4
case_images: A fine needle biopsy of the right clavicle was performed which confirmed metastatic pancreatic cancer (Figure 4).