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Fat Necrosis - Post Traumatic

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This is a 65-year-old female, is presenting

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with a palpable abnormality in the left breast.

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We obtained, uh, CC spot and MLO spot

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compression views over the palpable

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abnormality. Palpable abnormalities,

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uh,

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marked with a BB marker, which we can see here, here.

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And underlying the BB marker

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on this SM view, we see a, um, fat-containing

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mass, which looks well-circumscribed,

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essentially corresponding to that.

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And on the, uh, corresponding MLO view, you

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see a similar, uh, encapsulated fat-containing

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mass, which appears like it corresponds to the

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switch over to our DBT.

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We started the CC looking inferiorly first.

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Scroll through.

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As we get towards the superior part of the

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breast, we can, uh, see that there is a,

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uh, thinly encapsulated fat-containing mass.

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Which corresponds or is directly

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underneath the palpable BB marker.

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Now, there is some sort of heterogeneity around this,

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uh, with some density here posteriorly, which might

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make you wonder about that circumscribed margin.

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We switch over to the MLO side, scrolling

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from the lateral towards the medial.

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Eventually get to our, uh, corresponding thinly

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encapsulated fat-containing mass, which looks like

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it's directly underneath our palpable BB marker.

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Now, because of some of this heterogeneity, I would

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recommend that we do a diagnostic ultrasound here

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just to make sure we understand fully what we deal

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with here and get a better sense of the margins.

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Um, with ultrasound, patient did have an ultrasound.

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The sonographer looked at the left

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breast, uh, at the very clinical concern,

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which was the palpable abnormality.

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10 o'clock, seven centimeters

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from the nipple, underlying.

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There's an oval hypoechoic mass with

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posterior acoustic enhancement and some

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internal sort of, uh, echogenic components.

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Um, these don't demonstrate

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any, uh, associated vascularity.

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Now, on subsequent questioning, the patient said

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she recently, um, had a motor vehicle collision, uh,

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with some trauma to the breast and some bruising.

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And so these findings taken together are all

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compatible with, uh, palpable developing fat necrosis.

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And depending on your degree of certainty related

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to that, which I think we could be highly certain

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in this case, um, you can call it benign, uh,

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with no imaging follow-up needed, or if there's some

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diagnostic uncertainty, you could give this a BI-RADS

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3.

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Uh, with short interval follow-up, I'm hoping

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to see, uh, even more stereotypical findings

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of fat necrosis, uh, at a subsequent exam.

Report

Faculty

Ryan W. Woods, MD, MPH

Assistant Professor of Radiology

University of Wisconsin School of Medicine and Public Health

Tags

Women's Health

Ultrasound

Tomosynthesis

Oncologic Imaging

Mammography

Breast

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