0:00

41 year old female presents for a

0:03

baseline mammogram bilateral implants are

0:06

placed 10 years ago.

0:08

So these are her CC

0:11

and mlos use it's I will

0:14

tell you it's really hard to see it on these views. But look at this mammogram

0:17

and what number one what

0:20

type of implants does she have this is it saline or

0:23

silicone? And is it behind the

0:26

pack earned from the pack muscle?

0:29

So in this case, these are retropectoral so you

0:32

can see the pec muscle coming around the implant and they're saline

0:35

because you can see through them silicone implants tend

0:38

to be denser and they are more white and you won't

0:41

see this nozzle like you do in saline implants.

0:44

So they're they're retroxyl implants. But

0:47

what I will tell you that doesn't display that

0:50

well is that she's got some calcifications in

0:53

her left upper outer breasts.

0:56

And that I don't know if that's displaying well,

0:59

but they're there, okay.

1:02

so you're going to give her a buy red zero because

1:07

we need to call her back for additional diagnostic views.

1:11

What views should we get to further evaluate these calcifications?

1:17

CC and mlo Mags

1:19

CC and ml mag

1:23

Spa compression or xccl

1:33

so the correct answer is CC and ml

1:36

magnification views really there's

1:39

no indication for any mlmag. The

1:43

reason we're getting ml mag is to see if or

1:46

a true lateral magnification view is to

1:49

see if the calcifications layer okay, if they

1:52

layer it's benign milk of calcium. So that's really the best

1:55

way to see if something layers. So whenever I see an mlo magnification view

1:58

I kind of roll my eyes because there's really no

2:01

role for ML magnification. So if you see that

2:04

on a test, you could already exclude that

2:07

answer. So yeah, certainly for calcifications. We

2:10

want to get magnification always want to get CC and

2:13

ml not ml.

2:15

Okay.

2:16

So these are her calcifications.

2:21

If I had to use a descriptor, I would say that there they are

2:24

segmental pleomorphic calcifications. They

2:27

span a large extent. They stand about

2:30

10.5 centimeters.

2:33

Um, I don't always do an ultrasound. But in this case, I

2:36

felt like that there was maybe an underlying mass and she

2:39

was so dense. We've been doing a lot more survey ultrasounds. So

2:42

in this case we saw on a regular hypogic math

2:45

and the upper-adder quadrant. You can

2:48

see these little punctate echogenic Foci which corresponds

2:51

to calcifications.

2:54

You know, we're suspicious. We're going to look in her lymph node.

2:57

This is a birad four or five depending on

3:00

how confident you are. But certainly these are very

3:03

suspicious.

3:06

Like I said in this case actually we did it

3:09

under actually in this case. I think we did a stereo and

3:12

an ultrasound biopsy. Remember if you see

3:15

something on mammogram animal ultrasound you would like to buy obsc under ultrasound to

3:18

give you the better chance of getting invasive cancer if

3:21

there is any

3:22

This is what our Mr. MRI look like, you know,

3:25

so she's got this linear clumps non-mass enhancement in

3:28

the left upper outer breast.

3:30

That corresponds to where we saw the calcifications

3:33

and it certainly is suspicious.