Carotid Canal: An Extremely Rare Site of Metastases from Carcinoma Breast Depicted by 18-F/ FDG PET/CT Imaging

Diagnosing the disease earlier is of great importance in maximising the quality of life of the patient. We report a 60-year-old-female who presented with focal pain on right side of her face also involving eye and diplopia. Visual acuity, fundus and other ocular examination were within normal limits. Computerized Tomography (CT) detected lytic lesions in clivus, involving right carotid canal & medial part of greater wing of sphenoid on right side. Magnetic Resonance Imaging (MRI) reported tissue enhancement along clivus on right with involvement of petrous portion of the right internal carotid canal. Since patient was reluctant for any navigation-assisted surgery, whole body FDG PET/CT was offered. Whole body FDG PET/CT reported FDG avid lesion in right breast along with extensive distant deposits. Further mammogram and tissue biopsy was performed and FDG avid breast lesion was consistent with primary breast malignancy. FDG PET/CT played wonderful role not only in detecting primary site of malignancy but in upstaging and optimization of further treatment also. The ophthalmologists should be aware that breast metastases may be easily overlooked leading to a catastrophic late diagnosis when curative treatment may not be possible.