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

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.

Fat Necrosis - Post Traumatic

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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

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

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

Architectural Distortion

Lesson

Calcifications

Lesson

Associated Findings

Lesson

Postsurgical Findings

Fat Necrosis - Post Traumatic