59-year-old man with enlarging and painful left breast over 6 months
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Our next patient is a 59-year-old man with
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enlarging painful left breast for six months.
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So for this patient, we did a bilateral diagnostic
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mammogram and his problem was on the left side.
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So we can see that there's a large
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amount of tissue density on the left,
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really not very much on the right.
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And we can look at these images a
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little more closely with tomosynthesis.
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So here's the nipple on the left side, and then
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this tissue really looks almost like a female
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breast in this patient, but no mass or anything.
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There's just this tissue sort
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of centered behind the nipple.
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And this is, um, consistent with gynecomastia.
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So here's the MLO view and also
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the, uh, tomosynthesis images.
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This just looks like focal
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breast tissue, nothing else.
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And then we check the other side also.
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So here's the right side.
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And right tomosynthesis images.
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There may be a little bit of
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tissue behind that right nipple.
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Here's the CC view on the right and his nipple.
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Really maybe just a little bit of tissue there.
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And then this is his left breast ultrasound.
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So this is right under the nipple.
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There's a hypoechoic tissue extending
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into the surrounding tissue.
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And then we did a comparison
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of the right to the left.
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So there's a little bit on the right,
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but mostly it's on the left side.
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And interestingly, you know, the literature
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and appropriateness criteria say that you
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can, you know, if you do a mammogram and
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it looks like gynecomastia, you can stop,
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which is what we tried to do in this patient.
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We just called it gynecomastia.
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But then the referring provider said,
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"Yes, but there's a palpable lump."
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"I want an ultrasound."
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So the patient came back
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on a different day for the ultrasound,
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and it just showed gynecomastia.
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So I tend to do both exams for each patient.
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I do the diagnostic mammogram and the
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ultrasound, that way there's no question
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that we've left something undone.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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