0:00

In this case, we have a 71-year-old female

0:03

who's presenting for a screening mammogram.

0:07

I'm showing just images of the right breast, uh,

0:09

currently, and if we look at these SM views in

0:13

the CC view lateral aspect right here, we could

0:16

see this area that looks like it's potentially an

0:19

architectural distortion, right? Some spiculated

0:21

lines, central component here, more spiculated

0:24

lines, sort of that pulled-in type of appearance.

0:29

And we see here, we expect this to be in the lateral

0:31

aspect of the breast, approximately middle depth.

0:34

If we look over at the MLO view, we don't

0:37

necessarily see anything corresponding to that area

0:39

of architectural distortion, even though we might

0:41

expect some, with something this large, that we'd be

0:43

able to see it, uh, in the MLO projection as well.

0:47

So let's look through the DBT slices to try to

0:50

help us, uh, localize this area of distortion.

0:54

So let's start at the inferior breast.

0:56

Start to scroll through.

0:58

We're focusing our attention

0:59

right here as we scroll through.

1:01

We can see a couple lines here that look

1:03

almost, you know, pretty normal, right?

1:05

They're elongated.

1:07

We have sort of a rounded border to them as

1:10

we keep scrolling through. Get to here, see

1:12

something kind of similar, some more fat.

1:15

Um, but nothing ever actually

1:17

really resolves as a particular

1:21

area of distortion.

1:22

So we might back here to our SM view again, just

1:25

to make sure we're looking in the right area.

1:27

I think we are. Let's scroll

1:29

through there one more time.

1:30

Uh, looking for that distortion, I'd say, hmm.

1:33

Well, that's sort of curious.

1:34

I wonder what happened there.

1:35

Let's look through our MLO view

1:37

to see if we can see anything.

1:39

I'd be looking up at this area here.

1:42

Um, maybe something around here in the middle

1:44

of the breast, but as we scroll through, we

1:46

really don't see anything that looks abnormal.

1:49

This is a finding that I like

1:50

to call pseudo-distortion.

1:51

It looks like a distortion on the SM view, but when

1:54

you scroll through the DBT stack, you really don't see

1:56

anything that qualifies as a full normal distortion.

2:00

And the reason this happens is we have

2:02

overlapping tissue, which gives the appearance

2:05

of kind of linear lines radiating from a point.

2:09

Um, but when we scroll through, we see that those

2:11

lines are actually different portions of the breast.

2:13

So here we might see some lines more inferiorly,

2:17

these ones, and as we scroll superiorly, you

2:19

might get different lines going in different

2:21

directions, but when you lay them all together,

2:23

uh, it looks like, uh, a true distortion.

2:27

So the reason this, uh, happens is that some of those,

2:30

uh, reconstruction algorithms, um, developed by the

2:34

companies that make mammogram machines, um, have as

2:38

part of the algorithm, they try to sort of make it

2:42

overlapping structures look like

2:43

distortion in, in hopes that you more

2:46

readily identify true distortions.

2:48

But occasionally you do get an appearance where it's,

2:50

uh, a pseudo-distortion, not real, don't need to call

2:53

the patient back, um, for any further evaluation.

2:57

And I pull up the prior exam just for comparison.

3:00

Um, we can see the SM view doesn't have that

3:04

same sort of appearance, and if we scroll through

3:06

that same sort of location, you can see some of

3:08

those different lines that we saw previously,

3:11

which we believe led to the

3:14

appearance of a pseudo-distortion.

3:16

So when we compare the DBT stacks between the

3:18

two, it looks very much the same, very much

3:21

normal and unchanged, and this is a benign exam.

3:24

No need for any further evaluation,

3:27

she can return to routine screening.