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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
1 topic, 1 min.
7 topics, 21 min.
Welcome to Advanced Tomosynthesis Mastery Course
1 m.Introduction to Tomosynthesis (DBT) - Why Learn about Tomosynthesis?
3 m.Image Acquisition Technique, Positioning, and Physics
5 m.Screening & Diagnostic Performance of Tomosynthesis
4 m.CAD/AI in Tomosynthesis
2 m.Image Quality and Common Artifacts
8 m.Motion Artifact Case Example on Tomosynthesis
2 m.5 topics, 23 min.
10 topics, 29 min.
Normal Findings - Palpable Lump Focal Fibroglandular Tissue
4 m.Normal Findings - Palpable Lump Unilateral Axillary
4 m.Normal Findings - Palpable Lump Bilateral Axillary
4 m.Normal Findings - Screening Mammogram - Calcifications
3 m.Normal Findings - Screening Mammogram - Dermal Calcifications
3 m.Normal Findings - Screening Mammogram - Deodorant Artifact Example 1
4 m.Normal Findings - Screening Mammogram - Deodorant Artifact Example 2
3 m.Normal Findings - Screening Mammogram - Deodorant Artifact Example 3
2 m.Normal Findings - History of Lumpectomy
4 m.Normal Findings - Diagnostic Mammogram after Right Breast Masses on Screening
4 m.8 topics, 24 min.
Mammographic Asymmetries and Masses - Overview
7 m.Asymmetry - Invasive Ductal Carcinoma
3 m.Focal Asymmetry - Focal Fibroglandular Tissue - Benign
4 m.Developing Asymmetry
4 m.Solitary Mass - Fibroadenoma
2 m.Solitary Mass - Malignancy
3 m.Multiple, Bilateral Masses - Case 1
3 m.Multiple, Bilateral Masses - Case 2
2 m.3 topics, 4 min.
8 topics, 18 min.
5 topics, 17 min.
Architectural Distortion on Tomosynthesis - Imaging & Management - Overview
6 m.Pseudodistortion on Screening Mammogram, Normal on DBT
4 m.Architectural Distortion - Radial Scar / Complex Sclerosing Lesion
4 m.Architectural Distortion - Radiating Lines, Asymmetry / Invasive Ductal Carcinoma (IDC)
3 m.Architectural Distortion - Radiating Lines, Mass / Invasive Lobular Carcinoma (ILC)
3 m.8 topics, 22 min.
Calcifications on Tomosynthesis - Overview
5 m.Pseudocalcifications - Case 1
3 m.Pseudocalcifications - Case 2
3 m.Calcifications - Typically Benign - Milk of Calcium - Case 1
3 m.Calcifications - Typically Benign - Milk of Calcium - Case 2
2 m.Calcifications - Suspicious - Amorphous / Malignancy (BI-RADS 4B)
4 m.Calcifications - Suspicious - Coarse Heterogeneous / Benign
2 m.Calcifications - Suspicious - Segmental Fine Linear Branching / Invasive Ductal Carcinoma (BI-RADS 4C)
4 m.7 topics, 18 min.
Associated Nipple Retraction, Palpable Mass / Invasive Ductal Carcinoma
3 m.Axillary Adenopathy - Unilateral / Chronic Lymphocytic Leukemia (CLL)
3 m.Axillary Adenopathy - Bilateral / History of Chronic Lymphocytic Leukemia (CLL)
2 m.Skin Thickening - Prior Lumpectomy, Post Radiation
2 m.Skin Thickening, Asymmetry - Inflammatory Carcinoma / Invasive Ductal Carcinoma
4 m.Skin Thickening, Calcifications - Inflammatory Carcinoma / Invasive Ductal Carcinoma
3 m.Skin Thickening, Mass - Locally Advanced Breast Carcinoma
3 m.9 topics, 19 min.
Post Breast Reduction - Case 1
4 m.Post Breast Reduction - Case 2
2 m.Post Breast Reduction - Case 3
2 m.Post Lumpectomy - Benign Findings - Case 1
3 m.Post Lumpectomy - Benign Findings - Case 2
2 m.Post Lumpectomy - Recurrence
5 m.Post Lumpectomy - Benign Fat Necrosis
3 m.Silicone Injection
3 m.Concluding Remarks
1 m.0:00
This is a 65-year-old female, is presenting
0:04
with a palpable abnormality in the left breast.
0:09
We obtained, uh, CC spot and MLO spot
0:13
compression views over the palpable
0:15
abnormality. Palpable abnormalities,
0:17
uh,
0:19
marked with a BB marker, which we can see here, here.
0:23
And underlying the BB marker
0:25
on this SM view, we see a, um, fat-containing
0:28
mass, which looks well-circumscribed,
0:31
essentially corresponding to that.
0:33
And on the, uh, corresponding MLO view, you
0:35
see a similar, uh, encapsulated fat-containing
0:39
mass, which appears like it corresponds to the
0:44
switch over to our DBT.
0:47
We started the CC looking inferiorly first.
0:51
Scroll through.
0:52
As we get towards the superior part of the
0:54
breast, we can, uh, see that there is a,
0:58
uh, thinly encapsulated fat-containing mass.
1:02
Which corresponds or is directly
1:04
underneath the palpable BB marker.
1:06
Now, there is some sort of heterogeneity around this,
1:09
uh, with some density here posteriorly, which might
1:12
make you wonder about that circumscribed margin.
1:17
We switch over to the MLO side, scrolling
1:20
from the lateral towards the medial.
1:24
Eventually get to our, uh, corresponding thinly
1:28
encapsulated fat-containing mass, which looks like
1:30
it's directly underneath our palpable BB marker.
1:34
Now, because of some of this heterogeneity, I would
1:36
recommend that we do a diagnostic ultrasound here
1:38
just to make sure we understand fully what we deal
1:41
with here and get a better sense of the margins.
1:43
Um, with ultrasound, patient did have an ultrasound.
1:48
The sonographer looked at the left
1:49
breast, uh, at the very clinical concern,
1:51
which was the palpable abnormality.
1:53
10 o'clock, seven centimeters
1:55
from the nipple, underlying.
1:57
There's an oval hypoechoic mass with
1:59
posterior acoustic enhancement and some
2:01
internal sort of, uh, echogenic components.
2:04
Um, these don't demonstrate
2:06
any, uh, associated vascularity.
2:08
Now, on subsequent questioning, the patient said
2:10
she recently, um, had a motor vehicle collision, uh,
2:13
with some trauma to the breast and some bruising.
2:16
And so these findings taken together are all
2:19
compatible with, uh, palpable developing fat necrosis.
2:23
And depending on your degree of certainty related
2:26
to that, which I think we could be highly certain
2:27
in this case, um, you can call it benign, uh,
2:30
with no imaging follow-up needed, or if there's some
2:32
diagnostic uncertainty, you could give this a BI-RADS
2:35
3.
2:36
Uh, with short interval follow-up, I'm hoping
2:38
to see, uh, even more stereotypical findings
2:41
of fat necrosis, uh, at a subsequent exam.
Interactive Transcript
0:00
This is a 65-year-old female, is presenting
0:04
with a palpable abnormality in the left breast.
0:09
We obtained, uh, CC spot and MLO spot
0:13
compression views over the palpable
0:15
abnormality. Palpable abnormalities,
0:17
uh,
0:19
marked with a BB marker, which we can see here, here.
0:23
And underlying the BB marker
0:25
on this SM view, we see a, um, fat-containing
0:28
mass, which looks well-circumscribed,
0:31
essentially corresponding to that.
0:33
And on the, uh, corresponding MLO view, you
0:35
see a similar, uh, encapsulated fat-containing
0:39
mass, which appears like it corresponds to the
0:44
switch over to our DBT.
0:47
We started the CC looking inferiorly first.
0:51
Scroll through.
0:52
As we get towards the superior part of the
0:54
breast, we can, uh, see that there is a,
0:58
uh, thinly encapsulated fat-containing mass.
1:02
Which corresponds or is directly
1:04
underneath the palpable BB marker.
1:06
Now, there is some sort of heterogeneity around this,
1:09
uh, with some density here posteriorly, which might
1:12
make you wonder about that circumscribed margin.
1:17
We switch over to the MLO side, scrolling
1:20
from the lateral towards the medial.
1:24
Eventually get to our, uh, corresponding thinly
1:28
encapsulated fat-containing mass, which looks like
1:30
it's directly underneath our palpable BB marker.
1:34
Now, because of some of this heterogeneity, I would
1:36
recommend that we do a diagnostic ultrasound here
1:38
just to make sure we understand fully what we deal
1:41
with here and get a better sense of the margins.
1:43
Um, with ultrasound, patient did have an ultrasound.
1:48
The sonographer looked at the left
1:49
breast, uh, at the very clinical concern,
1:51
which was the palpable abnormality.
1:53
10 o'clock, seven centimeters
1:55
from the nipple, underlying.
1:57
There's an oval hypoechoic mass with
1:59
posterior acoustic enhancement and some
2:01
internal sort of, uh, echogenic components.
2:04
Um, these don't demonstrate
2:06
any, uh, associated vascularity.
2:08
Now, on subsequent questioning, the patient said
2:10
she recently, um, had a motor vehicle collision, uh,
2:13
with some trauma to the breast and some bruising.
2:16
And so these findings taken together are all
2:19
compatible with, uh, palpable developing fat necrosis.
2:23
And depending on your degree of certainty related
2:26
to that, which I think we could be highly certain
2:27
in this case, um, you can call it benign, uh,
2:30
with no imaging follow-up needed, or if there's some
2:32
diagnostic uncertainty, you could give this a BI-RADS
2:35
3.
2:36
Uh, with short interval follow-up, I'm hoping
2:38
to see, uh, even more stereotypical findings
2:41
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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