0:00

So 58 year old male with

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HIV and a palpable left breast, Mass.

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Here's the images.

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And the mass is marked with a palpable BB right here.

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Just this is that this every every institution that's something

0:19

different the institution. I was at when I found these images it

0:22

was a BB marker some places use a

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triangle. But in this case, it's a BB.

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So this is the first set of images.

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This is another set of images.

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And this is the ultrasound.

0:39

of the left palpable area

0:45

All right.

0:46

We can go to the question.

0:51

And I'll scroll back to I guess you can

0:54

scroll back to the mammogram to show to keep it on the screen for those

0:57

that want to take a second. Look bilateral gynecomastia,

1:00

very good, correct. So we see

1:03

that there is retro aerial or flame shapes tissue and

1:07

the BB is right on the flame

1:10

shape tissue. It's really important.

1:12

That if the baby is not on the gynecomastia that

1:15

you don't say the pebble was caused by

1:18

Gonic Massy if the BB is not on gynecomastia and the

1:21

guy make directly undergone capacity. You have to investigate it further. So

1:24

normally what you what what I do man. If a

1:27

patient is over 25 is going to come after you start with a mammogram

1:30

and really going to come out to the mammographic diagnosis and

1:33

you don't have to do the ultrasound. You want to just thought this helpful

1:36

area which we did to make sure there's no underlying mass and there isn't

1:39

and right the scary thing about going to come Matthew is it looks irregular it's

1:42

flame shapes, but it's retroare if

1:45

you want to make sure it's Central to the nipple. If it's ever

1:48

eccentric then you're concerned for a mass and on

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ultrasound. You see there's some breast tissue right behind the

1:54

nipple consistent with gynecomastia of corresponding to

1:57

the palpable.

1:59

And I answered this accidentally was ultrasound necessary.

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Let's see if you listen to me.

2:06

And go to 100% of you. Listen to me that ultrasound is

2:09

not necessary.

2:11

So bilateral again for Nastia. This guy the hint was

2:14

in the history he had HIV and

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so if someone has a known

2:20

diagnosis of HIV, they're usually on HIV medication and so

2:23

causes bilateral Gonic gynecomastia are HIV

2:26

medications antiretrovirals. Lots of

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other medications. I metadine anabolic steroids

2:32

for lactone are also causes. Another

2:35

thing is anything that increases the

2:38

estrogen in a man system such as

2:41

cirrhosis and liver failure marijuana. It's a

2:44

big one. Actually. It's a big thing when I see teenage boys that they

2:47

get very I tell them they smoking marijuana

2:50

can cause it. It's a very easy way to get them to stop

2:53

smoking and then very rarely breast cancer.

2:56

This is on the official differential diagnosis. I've never seen this bilateral

2:59

breast cancer and Men is almost always done a

3:02

command. Yeah.