0:00

In this case, we're gonna review the imaging

0:02

findings of a full face asymmetry seen in the right breast

0:06

on the screening exam. I fold down the right cleavage

0:10

view, and in the medial aspect of the right breast,

0:13

we see this, uh, asymmetry, which is identified by

0:17

the interpreting radiologist in the right MLO view.

0:22

We can look at the DBT image stack and scroll through.

0:27

And eventually we will see, very

0:29

subtly, this corresponding focal.

0:33

Now, one might wonder, of course, whether this thing

0:35

actually corresponds to what we're talking about.

0:37

And so we know that from this cleavage view, uh,

0:40

that this finding is in the medial right breast.

0:43

We would therefore expect our finding

0:45

to show up, be most apparent in the

0:47

medial aspect of the right breast.

0:49

So we can confirm that by looking at this

0:51

DBT stack, and we see that our score bar

0:53

shows us that we are in the medial aspect

0:56

of the right breast, and therefore this thing

0:59

probably likely corresponds to what we're talking about.

1:03

So this patient would then therefore

1:05

be sent on for diagnostic images to

1:08

verify that there's a finding there,

1:10

figure out what to do next.

1:12

So from her diagnostic exam, I'm gonna pull down

1:17

first, uh, the right CC spot view.

1:21

And then second, I'm gonna pull down an MLO spot view.

1:26

On the spot view in the synthesized, uh,

1:29

mammogram, we can see again our finding,

1:31

right? This focal asymmetry, uh, projecting

1:34

into the medial aspect of the right breast.

1:37

If we scroll through on tomosynthesis, we'll see

1:41

that it localizes to an area that looks like it's

1:46

a little bit superior, uh, in the right breast.

1:50

Let me pull down and...

1:54

scroll through here, and we'll see if we can find it.

1:56

So we're starting at the lateral edge and then

1:59

moving slowly, looking, focusing more on this upper

2:03

part of the breast to try and identify our focal.

2:07

And as we get very far medial, we see that it

2:10

comes into view or comes into the highest resolution.

2:15

And, uh, we can see it here now.

2:18

It was... I'm gonna make sure that this

2:19

corresponds with what we're thinking about.

2:21

So we thought it was gonna be medial, uh, it was

2:23

gonna be slightly superior, and it looks like it

2:25

very well matches up with that on the MLO.

2:29

This would help us, uh, in our discussion with

2:31

our ultrasound technologist if we were gonna

2:33

try and verify, um, or send this patient on to

2:35

ultrasound to see what we're looking at now.

2:37

A couple other things are also important too.

2:40

One, uh, is that we think, uh, because of where it

2:44

is in this breast, uh, and some imaging appearance,

2:47

we'll see these very low-density areas around

2:50

the mass that we think this might be either

2:52

very close to the skin or in the skin itself.

2:55

Um, our MLO view confirms this as well, right?

2:59

We can see these low-density cutaneous, uh,

3:01

skin, uh, fat deposits very well here, and

3:04

we assume we're probably in a very similar

3:05

area, uh, close to where our finding is.

3:09

So we can tell our technologist,

3:10

um, look at the upper inner breast.

3:13

This might be considered something like right two

3:15

o'clock posterior depths, looking for something very

3:18

close to the skin and perhaps the skin lesion itself.

3:22

And, uh, in this particular case, this

3:24

was determined to be a skin lesion.

3:25

Um, and in fact, our mammography technologist even

3:29

thought so as well beforehand, and she put what

3:32

we call a so-called mole marker on this thing

3:34

to say, "Hey, I see something on the skin right

3:36

at this spot too, and perhaps that corresponds."

3:39

And so we can see that even the

3:41

technologist saw it, uh, on the skin.

3:43

And so, doing our ultrasound, we're just verifying

3:46

this is in the skin and therefore considered

3:49

benign, and we don't need to do anything more about it.