CTICasesRib and Vertebral Pedicle Osteolysis from Metastatic Breast Cancer
Imaging findings
Chest radiograph demonstrates a missing segment of a left mid-posterior rib and an absent left vertebral pedicle (the "winking owl" sign). It also shows asymmetry from a prior left mastectomy. Chest CT confirms extensive osteolysis of the posterior rib and adjacent vertebral body with pedicle destruction by a metastatic breast cancer lesion.
Key takeaways
The complete absence of a rib segment or a vertebral pedicle on a chest radiograph can be easily overlooked due to visual habituation and "cognitive filling-in" of the bone contours. Radiologists should carefully examine the bony structures, looking for signs like the "winking owl" or missing ribs, particularly in patients with a history of breast cancer or other malignancies prone to osteolytic osseous metastasis.
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