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Breast MRI Case 2

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0:01

Alright, we're going to go to case 2 now.

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So, this is our compare and contrast case.

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And I'm going to start with this image here.

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What we've got here on the left is a

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the subtraction image and on the right, I've got the subtraction image.

0:19

And these really sort of have most

0:20

of the information, but I'm going to scroll up and down.

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Let's see if we can get this to zoom up a bit,

0:33

I'm just going to go up and down a little bit through that one on the

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left hand image on the subtraction image.

0:46

And you could put that poll up please, Ashley.

0:56

This is a 64-year-old lady.

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I'm going to withhold the rest of her history.

1:01

All right, let's look at the result of that one.

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All right, so we've got most people voting

1:05

here for Paget disease, which is correct.

1:08

This is Paget disease.

1:09

And you can see here, in this particular patient,

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that we really have very...

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Let me just go into this.

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We have very asymmetric, and in this case, superficial nipple enhancement.

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You see, it really is the skin of this right nipple that is enhancing.

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But not only that, we've got,

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and she did present with Paget disease of the nipple.

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We have this clumped segmental enhancement extending posteriorly,

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and it really extends pretty much all the way up to the nipple.

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You can see it coming up here in this area here, all the way up to the nipple.

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It's very much seems to be forming along the ducts.

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A very typical for DCIS.

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And this is what we call typical for a clumped enhancement pattern.

2:00

You can imagine it, just like little

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separate little foci of DCIS within that duct, but overall forming a segmental

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or triangular shape distribution with the tip pointed towards the nipple.

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Now, the other things that we talked about,

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we talked about inverted nipple, which we saw before.

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This nipple clearly is not inverted.

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Obviously the past case, what we thought it was going to end up

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being was a papilloma before we realized it was an inverted nipple.

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And if we're seeing little focal enhancing

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areas behind the nipple, they certainly are most typically a papillomas.

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But nipples do enhance normally, but they should enhance

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relatively symmetrically, although it's going to be an asymmetric

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distribution if one of those nipples is enhanced.

Report

Faculty

Petra J Lewis, MBBS

Professor of Radiology and OBGYN

Dartmouth-Hitchcock Medical Center & Geisel School of Medicine at Dartmouth

Tags

MRI

Implants

Breast

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