35-year-old woman with right bloody nipple discharge
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Our next patient is a 35-year-old woman
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with right bloody nipple discharge.
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So, this patient elected to have a 2D mammogram.
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We have bilateral CC views at the
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top of the screen, bilateral MLO
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views at the bottom of the screen.
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Because this patient is over 35, we started
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with a mammogram, and we can see that
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there are some calcifications here in
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the right lateral breast and right upper
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breast, nothing obvious on the other sides.
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We're just going to look a
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little more closely at this.
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So here's the right breast.
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There's some segmental calcifications
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here going toward the nipple.
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So here's the magnification
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view in the CC projection.
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And you can see all of these calcifications,
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kind of some coarse heterogeneous
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calcifications, some more amorphous
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calcifications in a segmental distribution,
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kind of going all the way up to the nipple.
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And then on the MLO view,
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you can see them again here.
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And we did a lateral magnification
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view, which is right here.
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You can see those calcifications
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pretty tightly grouped there.
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And then a couple of calcifications
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extending into the nipple.
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Um, so the calcifications alone are suspicious.
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And we went ahead and did an
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ultrasound as well for this patient.
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So here's the ultrasound that was performed.
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Here's her nipple, and right away we started
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seeing a duct with some echogenic flecks within
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it, which are the calcifications inside the duct
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tissues, very heterogeneous, but there were a lot
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of these calcifications were visible, no obvious
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mass, just the calcifications and the tissue was
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a little bit hypoechoic throughout that area.
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We also looked at, um, lymph nodes,
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which we thought were normal.
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But the interesting part of this was just.
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the ability to actually follow that duct
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and see the calcifications within it.
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Um, so for this patient, we thought we could
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see these calcifications best on the mammogram.
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So we recommended a stereotactic or a mammogram
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guided biopsy of those calcifications.
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And, um, this was ductal carcinoma in situ.
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And the process was extensive enough
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that the patient ended up opting
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to have a mastectomy for treatment.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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