0:01

Okay, next case. Oh, well, it's related case.

0:04

So 42 year old comes in for a

0:07

screening mammogram. What's the appropriate buyer ads?

0:10

Sorry for the old this is very old images, but

0:13

you get the point of the finding.

0:16

I think when I move my poll box.

0:24

So, you know, this is a little controversial but

0:27

technically this is a chew but you want to put something in your

0:30

report that this is that you know, they need to have some underlying systemic

0:33

disorder like well, let

0:36

me get to the next question.

0:40

So I'm not gonna even open this up but like

0:43

lupus HIV and flammatory

0:46

diseases can cause this and Dilantin as

0:49

a drug that can cause this but breast cancer should not

0:52

cause bilateral axillary lymphatinopathy.

0:55

It should really cause unilateral so

0:58

breast cancer would be least likely

1:01

cause of this appearance, but certainly, you know

1:04

for bilateral axial lymphadenopathy. It's usually something not breast

1:07

cancer, but it doesn't mean it's not important. This could definitely be lymphoma.

1:10

So often it requires just a conversation with

1:13

the doctor who ordered it.

1:15

You know, I looked through their chart. Sometimes I know they have shrogans or

1:18

rheumatoid and that would explain it. But I'll

1:21

put that in my report. But otherwise you want to make sure that's not

1:24

lymphoma, but it's still a two, you know,

1:27

even if you saw this and the patient really didn't have anything then I

1:30

would kind of be a call to the doctor. We could always sample one

1:33

of them if they you know, didn't have anything identifiable and

1:36

you wanted to make sure it wasn't lymphoma. But you

1:40

know, it's not breast cancer.

1:43

To believe likely causes not breast cancer. So these

1:46

are some bilateral x-ray lymph node causes. Like I said systemic disease

1:49

is like sarcoid mixed knesset tissue

1:52

disease granulomas is easy might see some horse calcifications

1:55

in them. Also lymphoma early

1:58

leukemia can certainly cause this and drug reaction from

2:01

Dilantin in the classic cause

2:04

but unilateral axialympadinopathy you

2:07

want to make sure like I said that it's not primary breast cancer with

2:10

ipsilateral spread and also infection or

2:13

granulomitous disease can cause that

2:16

or an extra capsular silicone leak, but that would usually

2:19

be like a high density lymph node.

2:23

Okay, great.

2:25

Moving on so, you know

2:28

axial lymphadenopathy some suspicious features you're going to have

2:31

they're going to be large you're gonna have loss of the normal fatty hilum.

2:34

You may see calcifications. It's always better evaluated with

2:37

ultrasounds the one and back you might want to call them. But when in doubt you might

2:40

want to call them back for an ultrasound.

2:45

Okay, so this is another case. I'm gonna

2:48

withhold the history.

2:50

But take a minute and look at this.

2:55

What causes this appearance?

3:00

So it will open.

3:05

This is gonna be radiation mastitis breast cancer

3:08

or gynecomastia.

3:11

Good, so everyone got that right? So yeah, this is flame shaped kind

3:14

of a mastia and you know

3:17

if it's a classic gynecomastia case on physical exam. It doesn't

3:20

even need a a mammogram. But

3:24

if you do you're what would

3:27

your buyer ads be?

3:31

piece on this

3:33

Good, you know so it's not negative because there is

3:36

a finding so I typically, you know reserve a negative for a

3:39

true negative study. This is a guy and he's

3:42

definitely got gynecomastia. He has a finding so

3:45

that I think this is a two I mean, it's not

3:48

it certainly benign or you know, so but

3:51

technically would be a two