A Fragmented Rib as the First Clue to Advanced Lung Adenocarcinoma

TL;DR

A severely fragmented rib can be an early sign of advanced lung adenocarcinoma, even before breathing symptoms occur.

Contribution

This paper presents a rare case where rib fragmentation was the first indicator of advanced lung cancer.

Findings

Rib destruction on imaging can precede respiratory symptoms in lung adenocarcinoma.

Uncommon radiographic features like rib fragmentation may signal underlying malignancy.

Abstract

Severe rib destruction on initial imaging can be the first clue to advanced lung adenocarcinoma with skeletal metastases, even before respiratory symptoms appear.

Osteolytic bone metastases are common in advanced lung cancer, particularly adenocarcinoma; however, here we present a rare case of a patient presenting with dramatic rib fragmentation. This case highlights the importance of recognising uncommon radiographic features that may reflect underlying malignancy.

Figures

Full text

A man in his 80s with a history of chronic smoking presented with left shoulder pain. Computed tomography (CT) of the shoulder incidentally revealed nodules in the right upper lobe of the lung. Chest radiography showed a banana‐shaped opacity and a tumorous shadow in the right lung field (Figure 1A). Chest CT identified a fragmented and markedly enlarged rib, consistent with osteolytic metastasis (Figure 1B,C). Additionally, CT showed a right upper lobe mass, pulmonary nodules, and mediastinal lymphadenopathy.

Laboratory testing revealed elevated carcinoembryonic antigen (502 ng/mL; normal ≤ 5) and alkaline phosphatase (1125 U/L; normal ≤ 322), suggestive of active tumour burden and bone involvement. A biopsy confirmed primary lung adenocarcinoma. Whole‐body evaluation revealed multiple skeletal metastases to vertebrae and ribs.

Osteolytic bone metastases are common in advanced lung cancer [1, 2], particularly adenocarcinoma, but such dramatic rib fragmentation at presentation is rare. It can easily be misinterpreted or overlooked if clinicians are not vigilant. This case highlights the importance of recognising uncommon radiographic features that may reflect underlying malignancy.

Author Contributions

H.I.: patient evaluation, manuscript drafting, image selection, final approval of the manuscript. T.U.: investigation; writing – review and editing, visualisation, final approval of the manuscript. Y.K.: writing   review and editing, final approval of the manuscript. H.K.: writing – review and editing, final approval of the manuscript.

Consent

The authors declare that written informed consent was obtained for the publication of this manuscript and accompanying images using the consent form provided by the Journal.

Conflicts of Interest

The authors declare no conflicts of interest.