Architectural Distortion - Radiating Lines, Asymmetry / Invasive Ductal Carcinoma (IDC)
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This is a 59-year-old female presenting for a routine
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screening mammogram. We're showing, uh, both
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the CC and MLO views. Uh, image quality looks
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appropriate, good pectoralis muscles and IMF.
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Looks good one.
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Profile, at least one view.
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Direct your attention to the right breast.
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If we first look at the CC view SM, we see a
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few scattered, typically benign calcifications
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and some scattered fibroglandular density breast tissue.
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There are no findings that stand
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out for the, uh, CC SM view.
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If we look at the SM right from the MLO view,
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we again see our scattered, uh, densities,
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typically benign calcifications, and then
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this asymmetry here, which sort of stands out.
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If we investigate that a little bit further
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with our tomosynthesis, we'll start in
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the lateral aspect and scroll medially.
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As we get to that point, we see, um, this
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asymmetry that does stand out amongst the,
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uh, remainder of the background tissue.
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Now, at this point, we're gonna call it an
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asymmetry 'cause we only see it on one view, but
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you might wonder if there's some radiating lines,
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uh, coming out from the CI that look like a little
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bit more straightened than you might expect.
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So we'd want to investigate that further.
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This patient was called back for this finding,
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and she subsequently had a diagnostic exam.
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We got an XCCL spot view,
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see if we could find that.
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Lo and behold, could you see the same,
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uh, similar appearing finding on the XCCL
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view, making this at least focal asymmetry,
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if not a mass. We see corresponding
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uh,
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asymmetry here on the upper right
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breast. Switch over to the DBT images,
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have a look at those, scrolling
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from the inferior aspect first.
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Um, and going superiorly, you would
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stop here, uh, at this finding here.
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And we at least look at this and
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think there might be a mass here.
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And I think you do see some radiating
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lines here, which, uh, are consistent with
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some associated architectural distortion.
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If we look at, uh, the MLO view again,
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we see something similar, right?
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Our mass is there again.
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We see some straightening lines,
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certainly a suspicious seizure, which warrants
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further evaluation with diagnostic ultrasound.
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This patient underwent a diagnostic
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ultrasound directed to the right breast.
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At 10 o'clock, we see a corresponding
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hypoechoic, irregular mass with some
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angular margins, some indistinct margins.
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Clearly corresponds to the imaging finding
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we see, uh, on the mammogram views.
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Uh, this was subsequently — it's
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compatible with ductal carcinoma.
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The patient went on for further treatment.
Ryan W. Woods, MD, MPH
Assistant Professor of Radiology
University of Wisconsin School of Medicine and Public Health
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