37-year-old woman with focal left breast pain
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Our next patient is a 37-year-old
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woman with focal left breast pain.
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So for this patient, we have bilateral
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CC views and bilateral MLO views.
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She is 37, so because she's over 30 years
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old, we'll start with a bilateral diagnostic
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mammogram. In this case, CC and MLO views
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of both breasts with tomosynthesis,
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and then we'll ultrasound the area of pain.
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So for her, we've put our little square marker in
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the left upper outer breast in the area of pain,
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and we'll take a closer look at these images.
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So here's her left CC view, and we'll go
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through her tomosynthesis images as well,
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and we can see that marker here
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on her skin in the lateral breast.
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There's some dense tissue underlying that,
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um, area, but nothing really standing out.
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Everything looks good, and we'll go to our MLO
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view, full size, then our tomosynthesis images.
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Scrolling through, the tissue looks normal.
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You can see our square marker on her skin here.
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I think as we were going through, we, we saw
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this asymmetry here in the central breast.
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Sometimes you find some incidental finding.
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So we went ahead and looked at that with a
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spot compression view.
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So here's our spot in that area.
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And the tissue effaces
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partially with spot compression.
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We did a lateral view as
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well, which looks very normal.
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And we did a lateral view with tomosynthesis.
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And I think, you know, in these patients who
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are between 30 and 40, if they're at normal
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risk, one of the challenges is that you have
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to be comfortable that you're not going to
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be seeing these patients again until age 40.
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So, we usually try to work up,
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um, other areas if we see them.
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So, really nothing suspicious,
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we've got our square marker again there.
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So, our next step for her
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would be to do ultrasound.sss
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So, this is her ultrasound in the
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area of pain, which is one o'clock,
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four centimeters from the nipple.
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So, we can see her skin,
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her subcutaneous fat, um, dense tissue here.
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And really tissue looks normal
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throughout that lateral breast where
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she stated that she had the pain.
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So it was from one, one o'clock to four o'clock
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position and all of that tissue looks normal.
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So for her, we decided this was normal and
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I think we gave her a BI-RADS category two
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because of the breast asymmetries, um,
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and then referred her back to her provider and
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recommended, uh, screening mammography at age 40.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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