By Catherine M. Appleton
Accomplished and to-the-point, Breast Imaging Cases covers the sector of breast imaging for the radiology resident and practitioner. a brand new addition to the Cases in Radiology sequence, this ebook follows the transparent and straight forward structure of challenge and answer, provided in a hundred special instances. that includes over four hundred photos, this situation e-book examines the spectrum of universal medical matters in breast imaging, together with vintage and often encountered diagnoses, in addition to infrequent findings. instances are geared up so as of accelerating hassle to facilitate studying and problem the reader to probe additional. below exam are the gamut of cysts, calcifications, benign plenty, and carcinomas present in breast imaging. The final portion of instances is devoted to breast MR. each one case is entire with suitable findings, differential diagnoses, administration, and broad instructing points.
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Extra resources for Breast Imaging Cases (Cases in Radiology)
Diagnostic Imaging Breast. , 2006:35-39. Stavros AT. Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins, 2004:276-350. 40 Case 20 History ▶ Painful, erythematous mass in the left breast, upper outer quadrant. The patient reports malaise and low-grade fever for 2 days 41 Case 20 Abscess Axilla 42 Findings ▶ Mammogram ■ Increased soft tissue density and an obscured mass at the 2 o’clock position (skin BB marker) ■ Trabecular thickening, skin thickening (arrowheads), and axillary adenopathy (arrows) ▶ Ultrasound: ■ Irregular, heterogeneously hypoechoic mass with a thickened rim and posterior acoustic enhancement ■ During real-time scanning, some mobile internal debris was evident.
2004:957-958. Ikeda DM. Breast Imaging: The Requisites. Philadelphia: Elsevier Mosby, 2004:239-2464. 30 Case 16 History ▶ Palpable mass in the right superior central breast (indicated by a metallic BB) 31 Case 16 Invasive Lobular Carcinoma (ILC) Findings ▶ Mammogram: Metallic BB marks a high-density lobular mass with partially circumscribed, partially obscured margins in the upper central right breast (circles) ■ The patient is status post remote benign excisional biopsy resulting in skin thickening and distortion anteriorly (arrows) ▶ Ultrasound: Irregular, hypoechoic solid mass with microlobulated margins with a non-parallel orientation Diﬀerential Diagnosis ▶ ▶ ▶ ▶ Invasive ductal carcinoma Medullary carcinoma Phyllodes tumor Atypical presentation of fibroadenoma (much less likely) Teaching Points ▶ May present as palpable mass or “thickening” ▶ Accounts for less than 10% of all invasive breast cancers ▶ Higher rate of multifocal, multicentric, and/or bilateral involvement compared to invasive ductal cancer (IDC) ▶ ILC has a variable appearance mammographically ■ Iso-dense or high-density mass with spiculated or indistinct margins ■ Architectural distortion ■ Developing density ■ Can be a one-view finding ■ Microcalcifications NOT a characteristic feature 32 ▶ Variable appearance on ultrasound ■ Hypoechoic irregular mass (shown in this case) ■ Diffuse acoustic shadowing ◆ More common with larger tumors ▶ Tumor cells grow in single-file lines, infiltrating between collagen bundles ■ This growth pattern is thought to contribute to the subtle presentation of some tumors ■ Notoriously difficult to detect mammographically Management ▶ BI-RADS® Category 5: Highly suspicious for malignancy ▶ Ultrasound-guided core-needle biopsy for tissue diagnosis ▶ When diagnosis of ILC is confirmed, contrast-enhanced MR should be considered ■ Delineate extent of disease for surgical planning ■ Evaluate the contralateral breast for clinically and mammographically occult disease Selected References/Further Reading Bassett LW, et al.
Ikeda DM. Breast Imaging: The Requisites. Philadelphia: Elsevier Mosby, 2004:315.