0:00

In this case, we have a 50-year-old female

0:02

presenting for a screening mammogram.

0:06

Image quality looks good,

0:08

uh, in the CC and MLO projections.

0:11

I'm gonna look at the left breast.

0:13

And if we look at these SM views, we have

0:16

heterogeneously dense breast tissue, a

0:19

few scattered round calcifications, which

0:22

are typically benign, and no additional

0:24

imaging findings that necessarily stand out.

0:28

When we switch over to the uh, DBT images, we'll

0:32

start at the inferior breast and scroll superiorly.

0:36

And if we're looking through, you

0:40

may not notice anything in particular

0:42

right away, but if you stop and focus.

0:48

Mostly on the lateral aspect, the left breast.

0:52

You can see here that there's an area that

0:55

looks like some potential distortion, right?

0:58

We see some radiating lines coming out

1:00

here, maybe even as far out as here.

1:03

Um, and it's a subtle finding, right?

1:05

Some of, there's some, some

1:06

straightening of lines here.

1:08

Certainly something that you might

1:10

wanna have a look at, uh, further.

1:14

Now, so far, this is a one view finding.

1:17

We can use our scroll ball to help us try

1:19

and determine where this is in the breast.

1:21

Um, it looks like we're more on the inferior aspect of

1:24

the breast and we know based on this view that we're

1:27

in somewhat sort of central to lateral lateral side.

1:32

So we'll switch over to our MLO view.

1:35

We'll start on the lateral side, and we'll be

1:37

looking, focusing more on the inferior part of the

1:39

breast to see if we can something that corresponds.

1:42

Now if we stop relatively soon, we can see

1:45

here, uh, in this inferior part of the US that

1:48

we see something that might correspond to it.

1:49

Here's some straightening of lines.

1:51

Looks like there's potentially some distortion,

1:53

um, going from a sort of central point as I scroll

1:57

through there, it might become more apparent as you

1:59

see the actual moving images rather than static image.

2:02

Um, but I would think about right here is probably as

2:05

good as you can get in terms of matching up a finding

2:07

that might correspond to what you see in the breast.

2:13

This patient did uh, end up getting a call back

2:16

for this architectural distortion and we got a

2:18

CC spot and the MLO spot in those similar areas.

2:22

Again, on the SM views, nothing really particularly

2:26

stands out surprisingly, but as we, um, looked

2:30

through the spot compression views, I think

2:34

maybe we could find something that stands out.

2:37

I get closer to the inferior margin.

2:38

Again, here you can see this area.

2:40

If I stop on it just exactly there, you can

2:43

see some radiating, uh, lines coming out from

2:46

this sort of central component, exactly where

2:49

we thought we saw things on the screening exam.

2:53

If we look on the MLO spot,

2:55

we again see the same area.

2:57

It shows some straightening of lines, some radiating

3:00

from a current point, um, which likely corresponds.

3:04

Distortion, and I would interpret this

3:06

as being a real architectural distortion

3:08

that needs some further evaluation.

3:10

This patient subsequently went on to have

3:12

an ultrasound and no, uh, corresponding

3:15

imaging finding was identified.

3:17

Now that's probably okay because, um,

3:20

this is heterogeneously dense tissue.

3:22

It's a little bit at least middle or posterior depth,

3:25

which can make it more difficult to identify, and

3:27

distortions can be very subtle on, on ultrasound.

3:30

So this patient, uh, went, underwent a subsequent

3:32

stereotactic-guided biopsy, and this was

3:35

demonstrated to be a radial scar without ATP.