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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Lesson
Sample Lesson
4 topics, 14 min.
Lesson
Palpable Lumps
5 topics, 16 min.
53-year-old woman with palpable lump in right breast
3 m.25-year-old woman with bilateral breast implants and palpable lump in right breast
2 m.78-year-old woman with palpable lump in right upper outer breast
5 m.54-year-old woman with palpable lump in left breast
5 m.38-year-old woman with palpable lump in right upper breast
5 m.Lesson
Breast Pain
3 topics, 7 min.
Lesson
Nipple Discharge
3 topics, 8 min.
Lesson
Skin Changes/Inflammation
10 topics, 23 min.
Skin Changes and Mastitis Overview
2 m.39-year-old woman with fever and cellulitis of the right breast, recently stopped breastfeeding
3 m.18-year-old woman with painful palpable lump in left breast
2 m.Granulomatous Mastitis Overview
2 m.29-year-old with palpable mass in left breast
2 m.31-year-old woman with palpable lump and skin redness in left breast
5 m.Inflammatory Breast Cancer Overview
2 m.55-year-old woman with skin thickening and redness in right breast
4 m.68-year-old woman with skin thickening and palpable lump in left breast
4 m.43-year-old woman with diffuse left breast pain and palpable lump. Family history of breast cancer
4 m.Lesson
Recall from Screening
29 topics, 1 hr. 7 min.
Asymmetry Overview
6 m.47-year-old woman recalled for asymmetry in left breast
4 m.59-year-old woman recalled for focal asymmetry in left breast
3 m.69-year-old woman recalled for developing asymmetry in right breast
4 m.46-year-old woman recalled for developing asymmetry in right breast
4 m.64-year-old woman recalled for calcifications and developing asymmetry
4 m.51-year-old woman recalled for developing asymmetry in right breast
3 m.79-year-old woman recalled for developing asymmetry in anterior right breast
4 m.Breast Mass Overview
2 m.43-year-old woman recalled for mass in left upper outer breast
3 m.40-year-old woman recalled for 12 mm mass in right breast
2 m.62-year-old woman recalled for mass in right upper outer breast
2 m.80-year-old woman with remote history of right mastectomy, recalled for mass in left breast
3 m.41-year-old woman recalled for mass in right breast
3 m.Architectural Distortion Overview
2 m.69-year-old woman recalled for architectural distortion in left breast
4 m.74-year-old woman recalled for architectural distortion in left breast
3 m.54-year-old woman recalled for distortion in left anterior breast
3 m.62-year-old woman recalled for distortion in left breast
3 m.Calcification Overview
1 m.54-year-old woman recalled for calcifications in left upper outer breast
2 m.57-year-old woman recalled for calcifications in left breast
2 m.51-year-old woman recalled for calcifications in right upper outer breast
2 m.60-year-old woman recalled for calcification in right breast
2 m.53-year-old woman recalled for calcifications in left breast
2 m.Large Axillary Lymph Node Overview
2 m.53-year-old woman recalled for large left axillary lymph node
3 m.80-year-old woman with history of breast cancer treatment recalled for large lymph nodes in left axilla
2 m.49-year-old woman recalled for asymmetry in left breast and large left axillary lymph node
3 m.Lesson
Surveillance After Breast Cancer Treatment
5 topics, 16 min.
Annual Surveillance after Breast Cancer Treatment Overview
4 m.57-year-old woman with history of right breast cancer 10 years ago. Annual follow up
3 m.62-year-old woman with history of left breast cancer 4 years ago. Annual follow up
4 m.61-year-old woman with history of left breast DCIS 10 years ago. Annual follow up
3 m.65-year-old woman with history of left breast cancer 12 years ago. Annual follow up
4 m.Lesson
Follow Up Probably Benign Findings - BI-RADS 3
5 topics, 16 min.
Follow Up Probably Benign Findings- BI-RADS 3 - Overview
8 m.60-year-old woman for 6 month follow up of probably benign calcifications in right breast
3 m.52-year-old woman for 12 month follow up of probably benign 5 mm oval mass in right breast
3 m.16-year-old girl for 6 month follow up of probably benign mass in right breast
3 m.56-year-old woman for follow up of probably benign clustered microcysts in right breast
4 m.Lesson
Follow up Benign Biopsy
3 topics, 5 min.
Lesson
Pregnant and Lactating Women
8 topics, 20 min.
Pregnant and Lactating Women Overview
6 m.26-year-old woman, 20 weeks pregnant, with left breast pain
2 m.32-year-old woman, 21 weeks pregnant, with palpable lump left breast
4 m.33-year-old lactating woman with palpable lump left breast
3 m.32-year-old woman, 1 year postpartum, breastfeeding, with palpable lump left breast
3 m.34-year-old woman, currently lactating, with palpable lump left breast
4 m.28-year-old woman, 1 year postpartum, with palpable lumps right breast
2 m.25-year-old woman, 1 month postpartum, breastfeeding, with palpable lump right breast
2 m.Lesson
Male Patients
5 topics, 12 min.
Symptomatic Male Patient Overview
4 m.65-year-old man with pain and palpable lump behind the left nipple for a few months
2 m.59-year-old man with enlarging and painful left breast over 6 months
3 m.77-year-old man with painful palpable lump in right subareolar breast
3 m.75-year-old man, BRCA2 carrier, with palpable lump in right breast
3 m.0:00
So our first case is a 53-year-old woman recalled
0:04
from screening for evaluation of a large,
0:06
uh, axillary lymph node in the left breast.
0:10
So these are the screening
0:11
images for this patient.
0:14
Everything looked pretty good, except that
0:16
one of the lymph nodes in the left axilla
0:20
was very prominent, no obvious fatty hilum.
0:25
I'll just look at that a little bit more closely.
0:29
This was the tomosynthesis images through
0:31
that lymph node, and you never really get to
0:34
a place where it looks like it has a fatty
0:35
hilum, so pretty big lymph node, and that
0:39
was larger compared to her prior mammogram.
0:44
So we went ahead and asked the patient
0:46
to come back in to have an ultrasound.
0:49
So we did an ultrasound as our next step.
0:53
And this was the ultrasound of the XLS.
0:56
So there's a very large lymph node over three
1:00
centimeters in size with an effaced fatty hilum,
1:04
very small fatty hilum, and very thick cortex.
1:08
Lots of internal blood flow.
1:11
The cortex here is measured at six
1:13
millimeters, but it's probably,
1:15
you know, even thicker in this section.
1:20
You know, there was actually a second lymph
1:21
node that was also large with a thick cortex.
1:25
And, um, the larger of the two lymph nodes
1:28
was recommended for ultrasound-guided biopsy.
1:31
So the patient had ultrasound-guided
1:33
biopsy and that showed metastatic carcinoma
1:37
consistent with a breast primary,
1:40
even though the mammogram looked totally normal.
1:42
And the next step in that situation
1:45
is usually to go on to a breast MRI.
1:48
to try to find the mass, which
1:50
sometimes can be very small.
1:52
And that's what happened in this patient.
1:54
She had an MRI of the breast, which demonstrated a
1:57
small mass, subsequently biopsied, and that was an
2:01
invasive ductal carcinoma, which was presumed to
2:04
be the source of this axillary nodal metastasis.
53-year-old woman recalled for large left axillary lymph node
HIDEInteractive Transcript
0:00
So our first case is a 53-year-old woman recalled
0:04
from screening for evaluation of a large,
0:06
uh, axillary lymph node in the left breast.
0:10
So these are the screening
0:11
images for this patient.
0:14
Everything looked pretty good, except that
0:16
one of the lymph nodes in the left axilla
0:20
was very prominent, no obvious fatty hilum.
0:25
I'll just look at that a little bit more closely.
0:29
This was the tomosynthesis images through
0:31
that lymph node, and you never really get to
0:34
a place where it looks like it has a fatty
0:35
hilum, so pretty big lymph node, and that
0:39
was larger compared to her prior mammogram.
0:44
So we went ahead and asked the patient
0:46
to come back in to have an ultrasound.
0:49
So we did an ultrasound as our next step.
0:53
And this was the ultrasound of the XLS.
0:56
So there's a very large lymph node over three
1:00
centimeters in size with an effaced fatty hilum,
1:04
very small fatty hilum, and very thick cortex.
1:08
Lots of internal blood flow.
1:11
The cortex here is measured at six
1:13
millimeters, but it's probably,
1:15
you know, even thicker in this section.
1:20
You know, there was actually a second lymph
1:21
node that was also large with a thick cortex.
1:25
And, um, the larger of the two lymph nodes
1:28
was recommended for ultrasound-guided biopsy.
1:31
So the patient had ultrasound-guided
1:33
biopsy and that showed metastatic carcinoma
1:37
consistent with a breast primary,
1:40
even though the mammogram looked totally normal.
1:42
And the next step in that situation
1:45
is usually to go on to a breast MRI.
1:48
to try to find the mass, which
1:50
sometimes can be very small.
1:52
And that's what happened in this patient.
1:54
She had an MRI of the breast, which demonstrated a
1:57
small mass, subsequently biopsied, and that was an
2:01
invasive ductal carcinoma, which was presumed to
2:04
be the source of this axillary nodal metastasis.
Report
Faculty
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
Tags
Women's Health
Ultrasound
Tomosynthesis
Neoplastic
Mammography
Breast
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