0:00

In this case, uh, we have a 50-year-old

0:02

female presenting for a screening mammogram.

0:06

Looking at image quality, we see the

0:08

spec a little bit less prominent.

0:11

We, of course, wanna look at.

0:13

Prior exams to see if the patient was able to be

0:15

pulled in, uh, into the machine a little bit further.

0:18

But if it's about the same on prior

0:19

exams, we'll probably let this go.

0:21

Our CC views look adequate.

0:23

Um, the only thing that would be, um, catch my

0:26

eye a little bit here is that, um, this nipple,

0:29

uh, is not in profile here on the right MLO view,

0:32

and it's sort of barely in profile on the CC view.

0:35

Um, those would sort of not be

0:37

the best, uh, quality images.

0:39

That being said, um, let's first

0:41

focus on the CC views in this case.

0:46

And in the right CC,

0:47

uh, we see this focal group of calcifications

0:50

here in the medial side of the right breast.

0:52

Um, we would, of course, uh, want to

0:54

scroll through the DBT imaging stack to,

0:57

uh, investigate a little bit further.

0:59

We'll start on the inferior

1:00

side and slowly scroll through.

1:02

And as we get to this, uh, focal group

1:04

in calcifications, we can see that it's

1:05

very, uh, close to the skin surface.

1:08

Um, we can see these cutaneous

1:10

fat deposits within the skin.

1:12

Here's, uh, potentially a little bit of a skin

1:14

fold, and here's the edge of the breast tissue.

1:16

So as we scroll through there, um, see.

1:19

We would at least wonder, well, is this

1:21

close to the skin or is this in the skin?

1:23

Not really sure.

1:25

They have a morphology that looks sort

1:26

of coarse heterogeneous, uh, in this image.

1:29

And of course, we'd wanna look back on prior

1:31

exam to see if they were stable or not.

1:33

That being said, we'll pull down the

1:34

right MLO view to also have a look and

1:37

see if we can find these calcifications.

1:40

Uh, if we go back to the, um, CC view momentarily,

1:43

um, we see that they're in the medial breast.

1:46

Um, we would say somewhere sort of projecting

1:49

a little bit inferior, um, off the scroll bar.

1:54

And so we'll pull down our MLO

1:55

view and have another look.

1:57

I'm gonna, uh, increase the size

1:58

of it a little bit on this SM view.

2:01

And if we look in the breast parenchyma in

2:03

general, we don't really see anything that

2:04

matches up with the finding that we're looking at.

2:06

However, if we look a little bit inferiorly here,

2:09

we can see some calcifications which look like

2:11

they're projecting directly along the skin line.

2:14

Um, if we switch over to our DBT stack again,

2:18

we can see the nipple's not in profile 'cause we

2:20

see it pointing almost directly laterally.

2:22

Um, we can see it on that first, uh, lateral slice.

2:26

And as I scroll through, we'll eventually get to the

2:28

point, uh, where we're more on the medial side of

2:30

the breast where we expected those calcifications to be.

2:32

Know that we're in the medial side by,

2:34

um, looking at the scroll bar here.

2:36

And we can see these calcifications

2:38

track directly over the skin.

2:40

Here, and therefore proving these are in

2:42

the skin itself, not anywhere deeper in

2:44

the breast, and therefore can be considered

2:46

benign and no further workup is needed.

2:48

These are benign, uh, typically benign skin

2:51

calcifications, and we can just, uh, merely routine,

2:54

uh, recommend routine screening for the patient.