This is an excellent case for the film viewing component of the FRANZCR part 2 examination. A constellation of findings lead to multiple pathology in this study, all related to the underlying diagnosis of right breast cancer.
1. A cavitating lesion in a patient with history of breast carcinoma carry two main considerations: cavitating metastasis or fungal infection. The mnemonic that helps one to remember the differentials of a cavitating lung lesion is:
T I G S
T = Tumor (primary such as SCC, secondary such as TCC, sarcoma etc), I = Infection (abscess, fungal etc), G = Granulomatous inflammation (Sarcoid, Silicosis, Rheumatoid arthritis, Wegener granulomatosis), S = Septic emboli
2. Multiple pulmonary nodule in this patient can be due to fungal infection or metastatic spread.
3. Typical findings of radiation induced fibrosis (dense paramediastinal consolidation along the radiation field, traction bronchiectasis and sharply delineated lateral margins).
4. Extensive skeletal metastases