0:00

The BI RADS Atlas describes those three specific findings on mammogram and

0:05

three specific findings on ultrasound, which they say are appropriate to

0:10

give a BI RADS 3 assessment based on

0:15

evidence based study. But they also state that radiologists can use the

0:21

BI RADS 3 category based on their own experience.

0:25

And one example of this is post trauma. This is when a patient

0:28

comes in and has a good history of trauma. Maybe they had a

0:34

car accident or they hit this area of their breast and they're coming

0:39

in with a finding that you think is consistent with trauma,

0:41

but aren't able to conclude with 100% certainty.

0:46

Here's an example of that. This patient came in after having a car

0:50

accident and now feeling a new lump in her right breast.

0:52

And you can see this triangular shaped marker

0:58

overlying the inner upper breast, which indicates that this is the area

1:02

of palpable concern. And we see this kind of focal bordering on globally

1:10

symmetry in the upper inner right breast, directly underlying that triangular

1:16

shaped marker. So it's sort of this whole area here that's standing out.

1:25

And this was a change from prior exams, but given her history and

1:29

the fact that this is where she's feeling this area,

1:33

and this was the area where she hit during her car accident, this

1:40

probably falls into that category based on radiologist experience to give

1:43

a BI RADS 3. The BI RADS Atlas suggests having the patients come

1:48

back in one month, but there's been more recent data to suggest that

1:52

one month is probably not long enough to allow that finding to change

1:56

in a way to give a final assessment to determine whether it's suspicious

1:59

or not. We, our group typically uses three months and there are several

2:06

other groups and there's other expert recommendation to use more of three

2:11

months to follow up trauma to give that finding enough time to declare

2:15

itself. So here's our baseline. This is our exam that we give a BI RADS

2:24

3 to. And this is when they came in three months later.

2:30

And now you can see that area that we were worried about,

2:32

we're seeing all of these new calcifications. I'm just going to zoom in

2:37

on them so you can see them a little bit better here.

2:42

This has a very classic appearance of fat necrosis. You can see these

2:46

kind of curvilinear densities. Looks like they're kind of outlining circles

2:52

of fat. And this is a typical appearance of fat necrosis, which is

2:55

a benign demographic finding. I just want to show you the MLO views as

3:01

well. So here's our initial MLO view and then

3:07

our follow up MLO view. Let's zoom in on that finding again.

3:15

You can see here these kind of curvilinear calcifications that seem to kind

3:19

of border on areas of fat. This looks very typical for fat necrosis. So

3:24

at this three month follow up, we feel

3:28

confident that these changes we saw in the breast are due to the

3:31

car accident that the patient had and we can now give this time a BI RADS

3:35

2.