some cases, axillary recurrence may present as a new-onset lymphedema. Although lymph­edema may occur many years after treatment, its onset should prompt the consideration of regional recurrence, especially if no other expla­nation for its arrival is noted. In other cases, axillary or supraclavicular recurrences may present as pain in the arm and shoulder or increasing sensory or motor loss in the arm or hand. These symptoms are often as a result of brachial plexus involvement (although they may be caused by cervical spine metastases). CT, magnetic resonance imaging (MRI), and bone scan can help make the diagnosis and should be considered in any patient with new onset pain, paralysis, paresthesias, or lymph­edema, even in the absence of palpable disease. Internal mammary recurrences often present as a deep, fixed mass in an intercostal space at the ipsilateral sternal border. These often first pres­ent with pain and tenderness, without a notice­able mass. It may be difficult to differentiate from a chest wall recurrence or sternal metasta­sis. Also in the differential of parasternal pain are costochondritis (Tietze syndrome), neu­roma, or radiation-induced sarcoma. Persistent pain should prompt a CT, bone scan, or MRI to make the diagnosis.