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HISTORY: Patient with recurrent breast cancer, known (1)________ metastasis and increased alkaline (2)________.

INTERPRETATION: The chest x-ray shows (3)________ curvature of the thoracolumbar spine. Heart size is normal. Lung fields are clear. There is a metal (4)________ at the right base. The findings are unchanged from the 1990 film and no metastasis or effusion is identified.

An isotope bone scan following 24 millicuries of technetium 99 m Osteolite shows a prominent and intense pattern of (5)________ uptake that represents a change in comparison to the April 1990 film. Intensity of calvarial uptake is considerably higher than the facial bones and cervical spine, and shows a slightly (6)________ pattern. The patient has not had any intervening radiation therapy, and I think that these findings are suspicious for metastatic involvement in the calvaria. There is some increased (7)________ to the thoracolumbar spine related to the patient's scoliosis and unchanged from the 1990 film. The remainder of the skeleton, including the ribs, pelvis and extremities, is stable and unremarkable.

IMPRESSION: Chest shows scoliotic curvature unchanged from the 1990 film, with clear lungs and showing no evidence of (8)________ disease.

Isotope bone scan shows that since 1990, the patient has developed (9)________ increased calvarial uptake that has a slightly mottled pattern and is highly suspicious for metastatic disease to the calvaria. The remainder of the bone scan is stable, showing scoliosis and secondary increased uptake through the thoracolumbar spine, but no other specific bone (10)________ of metastatic disease are identified.

Marked as best answer by Dylan

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1. hepatic
2. phosphatase
3. scoliotic
4. shadow
5. calvarial
6. mottled
7. uptake
8. metastatic
9. diffuse
10. sites

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