Delayed Chest Wall Osteoradionecrosis with Pseudomonal Empyema Neccesitans: A Cataclysmic Adverse Effect of Radiation Therapy Post Modified Radical Mastectomy

The inclusion of adjuvant chemoradiation, especially in the form of whole breast radiation therapy, has been seen to reduce chances for future recurrences and provide long-term survival benefits [1]. Several early and late toxicities of radiation treatment are known, which include lymphoedema, skin changes, breast fibrosis, pneumonitis, pericarditis, and secondary malignancies [2]. The risk of an RT-induced rib cage fracture is low, with reports ranging from 0.3 to 1.8% [2], and it seldom transforms into osteoradionecrosis (ORN). The diagnosis lies mostly with imaging studies and the biopsy of the soft tissues and the bony component, which will demonstrate extensive inflammatory necrosis. Less than five cases of pseudomonal empyema have been reported in the literature and are usually seen in the immunocompromised. Treatment modalities available comprise source control of infection, extensive debridement, targeted antibiotics, hyperbaric oxygen, and finally reconstruction in cases of loss of framework [3]. Herein, we present the case of a 63 years old female who had the didactic recherche combination of both rare syndromes in one setting and her effective sequential management.