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This case, we have a 42 year old female presenting for a screening

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mammogram. Image quality looks appropriate. We've got great views of the

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pectoralis muscles and IMFs, both perfect. We focus our attention onto the

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left breast in this case. We have left CC and left MLO views.

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Looking at the SM views, nothing stands out particularly strong in either

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view. You might wonder a little bit about this sort of roundish appearing

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asymmetry here on the left CC, so we'll focus our attention on that

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area. We start on the inferior aspect of the left breast and we'll

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focus on that left outer breast as before. And again, as we sort

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of stop right about here, we can see this asymmetry here in the

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lateral aspect of the left breast. It does look a little bit more

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rounded. We do see some interspersed fat within it, and it's a little

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bit hard to tell the margins. There might be some concave aspects of

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it, margins might be a little bit indistinct. Maybe you're sort of wondering

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as there's maybe some circumscribed margins there. We switch over to the

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left MLO view, trying to find something corresponding. We see that we're

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sort of somewhere in the middle of the imaging stack,

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and if we scroll through, we're looking for something that corresponds to

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that same area. Now it's a little difficult to tell,

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but the interpreting radiologist for this case thought that this area here

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potentially matched up to that same asymmetry we see on the CC view. It

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looks like it's in maybe the middle of the imaging stack,

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which is good, in terms of what we expected from the CC view. However,

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on here it seems like it's projecting more on the superior side,

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which would not match up very well with

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our DVT slices from the CC view. Regardless,

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they were concerned enough about it, so recommended diagnostic mammogram

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to evaluate further. We pull over the spot compression views for this same

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case here, left CC spot compression and left MLO spot compression. We'll

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scroll through the DVT slices again on the CC and again,

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we see the similar area that sort of stands out a little bit

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as an asymmetry. Maybe some rounded components of it certainly stands out

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from the background, fibroglandular tissue. Again, on our MLO spot compression,

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we look at that same area. It does seem like it might match

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up reasonably well. It's the only thing that looks a little bit kind

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of rounded and a little bit more focal compared to the rest of

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the glandular tissue, but still, as we scroll through the terminal slices,

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it doesn't stand out as a distinct entity, so the rest of the

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glandular tissue sort of leads into or obscures this finding,

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it doesn't really stand out as something that really jumps out at you.

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This patient subsequently went on to have an ultrasound exam and we directed

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the sonographer to look in the left breast at two o'clock,

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maybe middle depth and have a look and see if we can see anything

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there. To pull over that ultrasound, we can see the sonographer did indeed

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look in the left breast at two o'clock and approximately 9 cm from the nipple.

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We do see some underlying dense fibroglandular tissue.

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There's maybe a little bit of a margin here that's sort of a distinct edge

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of that fibroglandular tissue, but nothing stood out in that area to correspond

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to what we're seeing. So this was subsequently interpreted as just focal

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fibroglandular tissue, a benign focal asymmetry. And what we hope to prove

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on future exams is that area stays the same and therefore,

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nothing else to worry about. She can just go back to routine screening.