0:00

In this case, uh, we have a screening

0:02

exam from a 69-year-old female.

0:06

We're demonstrating the right CC, left

0:08

CC, right MLO, and left MLO views.

0:11

Um, these are the synthesized mammography views.

0:15

And if we look broadly, we see the positioning,

0:17

uh, is at least adequate, a little bit asymmetric.

0:20

This left MLO pectoralis muscle is

0:22

a little bit less than the right.

0:25

Um, we see nipples, uh, in profile,

0:28

literally great on this CC view and MLO

0:31

view, a little bit angled or rotated on the...

0:39

Uh, in this case, we see diffuse coarse,

0:42

uh, calcifications in both breasts.

0:45

And if I pull down just the MLO views to look at, um,

0:50

we might wonder, hmm, where are these calcifications?

0:53

Um, you know, you might be

0:55

comparing them to prior thinking.

0:56

Are there, is there anything new here?

0:57

Um, and where am I gonna find these?

1:00

And how am I gonna describe the...

1:01

We switch over to the DBT views as we scroll through.

1:05

We notice that even on the very first slice, and

1:07

right now we are, uh, in the lateral aspect of

1:10

the breast, that we see these calcifications,

1:13

uh, with really high resolution already.

1:16

That, by definition, means that these

1:18

calcifications are dermal calcifications.

1:20

As we scroll through the image data set,

1:23

for the most part, we don't see any calcifications

1:25

within the actual breast parenchyma, but

1:27

as we get to the far medial, of course,

1:30

these calcifications, again, come into view.

1:33

Now you might notice that we're not

1:34

at the very end of the image stack.

1:36

This is, uh, related to the fact that we're adding

1:38

some slices on this medial aspect, meaning the

1:41

detector is on this medial aspect of the breast,

1:43

which is what we would expect from an MLO view.

1:46

And we can see these calcifications are...

1:48

At their highest resolution,

1:49

probably about right here.

1:51

We can also use the fact that we see some of these

1:53

low-density circles around here to note that we

1:55

are very close to the skin or in the skin, and

1:57

those are those cutaneous, uh, fat deposits.

2:00

So we can prove with tomosynthesis that these

2:03

calcifications are therefore in the skin,

2:05

dermal calcifications, and are therefore

2:07

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

2:10

On the left hand MLO, we see something very similar.

2:12

Again, we see them at the highest

2:13

resolution, a few slices in.

2:16

And we can also tell that, um, like

2:19

many dermal calcifications, they have

2:21

a rim type of, uh, configuration.

2:23

Um, and these are classic dermal calcifications.

2:26

Nothing to worry about.

2:28

Move on to the next case.

2:29

You're good.

Approach to Dermal Calcifications

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Pro Tip: Click on a word in the transcript to jump to that point in the video

0:00

In this case, uh, we have a screening

0:02

exam from a 69-year-old female.

0:06

We're demonstrating the right CC, left

0:08

CC, right MLO, and left MLO views.

0:11

Um, these are the synthesized mammography views.

0:15

And if we look broadly, we see the positioning,

0:17

uh, is at least adequate, a little bit asymmetric.

0:20

This left MLO pectoralis muscle is

0:22

a little bit less than the right.

0:25

Um, we see nipples, uh, in profile,

0:28

literally great on this CC view and MLO

0:31

view, a little bit angled or rotated on the...

0:39

Uh, in this case, we see diffuse coarse,

0:42

uh, calcifications in both breasts.

0:45

And if I pull down just the MLO views to look at, um,

0:50

we might wonder, hmm, where are these calcifications?

0:53

Um, you know, you might be

0:55

comparing them to prior thinking.

0:56

Are there, is there anything new here?

0:57

Um, and where am I gonna find these?

1:00

And how am I gonna describe the...

1:01

We switch over to the DBT views as we scroll through.

1:05

We notice that even on the very first slice, and

1:07

right now we are, uh, in the lateral aspect of

1:10

the breast, that we see these calcifications,

1:13

uh, with really high resolution already.

1:16

That, by definition, means that these

1:18

calcifications are dermal calcifications.

1:20

As we scroll through the image data set,

1:23

for the most part, we don't see any calcifications

1:25

within the actual breast parenchyma, but

1:27

as we get to the far medial, of course,

1:30

these calcifications, again, come into view.

1:33

Now you might notice that we're not

1:34

at the very end of the image stack.

1:36

This is, uh, related to the fact that we're adding

1:38

some slices on this medial aspect, meaning the

1:41

detector is on this medial aspect of the breast,

1:43

which is what we would expect from an MLO view.

1:46

And we can see these calcifications are...

1:48

At their highest resolution,

1:49

probably about right here.

1:51

We can also use the fact that we see some of these

1:53

low-density circles around here to note that we

1:55

are very close to the skin or in the skin, and

1:57

those are those cutaneous, uh, fat deposits.

2:00

So we can prove with tomosynthesis that these

2:03

calcifications are therefore in the skin,

2:05

dermal calcifications, and are therefore

2:07

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

2:10

On the left hand MLO, we see something very similar.

2:12

Again, we see them at the highest

2:13

resolution, a few slices in.

2:16

And we can also tell that, um, like

2:19

many dermal calcifications, they have

2:21

a rim type of, uh, configuration.

2:23

Um, and these are classic dermal calcifications.

2:26

Nothing to worry about.

2:28

Move on to the next case.

2:29

You're good.

Report

Faculty

Ryan W. Woods, MD, MPH

Assistant Professor of Radiology

University of Wisconsin School of Medicine and Public Health

Lesson

Pre-Course Activities

Lesson

Introduction to Tomosynthesis

Lesson

Approach to Interpretation and Lesion Localization

Lesson

Normal Imaging Findings

Lesson

Asymmetries and Masses

Lesson

Gynecomastia

Lesson

Fat-containing Lesions

Lesson

Architectural Distortion

Lesson

Calcifications

Lesson

Associated Findings

Lesson

Postsurgical Findings

Approach to Dermal Calcifications