0:00

This is a 59-year-old female presenting with a left

0:03

breast palpable abnormality, showing you, uh,

0:07

full-field CC and MLO views of the left breast.

0:09

We see our palpable BB marker, um, in the upper

0:13

inner breast, probably approximately 11 o'clock.

0:18

On these SM views, we can see some scattered

0:21

round calcifications, which look typically benign.

0:24

On the CC view, there's some suggestion of

0:26

asymmetry here in the more medial breast,

0:29

potentially corresponding with a palpable marker.

0:31

And on the MLO view, we see this area

0:34

here with some potential architectural

0:36

distortion here in the upper breast, which

0:37

might correspond to this palpable marker.

0:41

We switch over to the DBT views.

0:42

We'll scroll from the inferiorly

0:44

to superiorly first.

0:47

As we scroll through, she's got heterogeneously

0:50

dense tissue, but if we stop about right

0:52

here, we can see some associated architectural

0:54

distortion and some potential mass here.

0:56

Right now there's lots of radiating lines coming down,

0:59

all directions here, going posteriorly, medially,

1:04

actually laterally here, and this looks like

1:06

it corresponds directly to the palpable finding.

1:08

I'm gonna scroll back to where we

1:09

thought this was the worst area.

1:12

I'll leave that there for a moment.

1:14

If we look at the MLO view,

1:16

we can see, uh, that as we scroll from lateral

1:20

to medial, we get to this point here. We can

1:23

see a large area of architectural distortion

1:25

and a mass, and we see our radiating lines

1:27

here going out in almost all directions.

1:30

Um, and this, uh, is clearly a true, uh, mass

1:34

and architectural distortion finding, which

1:35

warrants further workup with an ultrasound.

1:39

Patient did go on and have an ultrasound.

1:41

We see a large area, uh, at 11 o'clock, five

1:44

centimeters from the nipple, which is heterogeneously,

1:47

hypoechoic, angular, and indistinct margins,

1:50

maybe a little bit of that hyperechoic halo, with

1:53

posterior shadowing and some associated vascularity.

1:56

This corresponds with the finding that

1:58

we saw in the left breast at 11 o'clock on

2:00

the mammogram with that area of distortion,

2:04

and this is highly suspicious for mal—

2:09

Said need clip from that side on the left side.

2:15

Um, we can scroll through and you can see some

2:17

areas that look like there's some potentially

2:19

radiating lines coming out from, uh, this mass.

2:22

And that's the distortion that

2:24

we see on the mammogram as well.

2:25

You can tell on the ultrasound it's

2:26

a lot more difficult to appreciate

2:28

distortion, um, but it's clearly evident.

Architectural Distortion - Radiating Lines, Mass / Invasive Lobular Carcinoma (ILC)

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0:00

This is a 59-year-old female presenting with a left

0:03

breast palpable abnormality, showing you, uh,

0:07

full-field CC and MLO views of the left breast.

0:09

We see our palpable BB marker, um, in the upper

0:13

inner breast, probably approximately 11 o'clock.

0:18

On these SM views, we can see some scattered

0:21

round calcifications, which look typically benign.

0:24

On the CC view, there's some suggestion of

0:26

asymmetry here in the more medial breast,

0:29

potentially corresponding with a palpable marker.

0:31

And on the MLO view, we see this area

0:34

here with some potential architectural

0:36

distortion here in the upper breast, which

0:37

might correspond to this palpable marker.

0:41

We switch over to the DBT views.

0:42

We'll scroll from the inferiorly

0:44

to superiorly first.

0:47

As we scroll through, she's got heterogeneously

0:50

dense tissue, but if we stop about right

0:52

here, we can see some associated architectural

0:54

distortion and some potential mass here.

0:56

Right now there's lots of radiating lines coming down,

0:59

all directions here, going posteriorly, medially,

1:04

actually laterally here, and this looks like

1:06

it corresponds directly to the palpable finding.

1:08

I'm gonna scroll back to where we

1:09

thought this was the worst area.

1:12

I'll leave that there for a moment.

1:14

If we look at the MLO view,

1:16

we can see, uh, that as we scroll from lateral

1:20

to medial, we get to this point here. We can

1:23

see a large area of architectural distortion

1:25

and a mass, and we see our radiating lines

1:27

here going out in almost all directions.

1:30

Um, and this, uh, is clearly a true, uh, mass

1:34

and architectural distortion finding, which

1:35

warrants further workup with an ultrasound.

1:39

Patient did go on and have an ultrasound.

1:41

We see a large area, uh, at 11 o'clock, five

1:44

centimeters from the nipple, which is heterogeneously,

1:47

hypoechoic, angular, and indistinct margins,

1:50

maybe a little bit of that hyperechoic halo, with

1:53

posterior shadowing and some associated vascularity.

1:56

This corresponds with the finding that

1:58

we saw in the left breast at 11 o'clock on

2:00

the mammogram with that area of distortion,

2:04

and this is highly suspicious for mal—

2:09

Said need clip from that side on the left side.

2:15

Um, we can scroll through and you can see some

2:17

areas that look like there's some potentially

2:19

radiating lines coming out from, uh, this mass.

2:22

And that's the distortion that

2:24

we see on the mammogram as well.

2:25

You can tell on the ultrasound it's

2:26

a lot more difficult to appreciate

2:28

distortion, um, but it's clearly evident.

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