64-year-old woman recalled for calcifications and developing asymmetry
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So our next patient is a 64-year-old
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woman who was recalled from screening
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for evaluation of calcifications on
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the right and an asymmetry on the left.
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So it's not uncommon that your,
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the recall is for more than one thing.
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And it may be for more than one side.
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So it's easy to, um, you know, kind of
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get lost in the details, but you have to
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fully work up each area that was recalled.
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So, here's our screening mammogram for
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this patient, and she was recalled for this
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developing asymmetry, which was here in
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the left upper outer breast, and then some
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calcifications in the right inner breast.
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So when we brought her back, we did some
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magnification views of the calcifications,
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which is our normal protocol.
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So this was the CC magnification
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view of these calcifications.
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So there's a little group of calcifications,
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but also a little density with them.
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So, although this is likely going to be fat
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necrosis, you know, there was some concern
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about the increased density around that area.
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And then we did the extra views
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on the developing asymmetry.
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So here's the CC magnification view and
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Lateral magnification view.
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And then of course these both had tomosynthesis,
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so this is the MLO spot compression view.
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You can see there may be a little bit
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of distortion in here, and it looks like
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there's a central kinda density there.
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And this is the CC spot compression view.
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So that area of density really doesn't go away,
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you know, and there may be
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something that we can find with
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ultrasound.
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So we did ultrasound of the
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area of developing asymmetry.
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And interestingly, you know, here's,
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here's a mass hypoechoic mass with a
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little bit of echogenic area in the center,
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and it's about eight millimeters in size.
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And there's a little bit of echogenic tissue
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around it that probably is it's making up the
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rest of the asymmetry because it's not just
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this mass, it's probably the tissue as well.
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So this could be a target for biopsy.
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This could either be biopsied using mammogram
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guidance or ultrasound guidance, but you
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know, something truly developing in that
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area over time, we would want to biopsy that.
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The calcifications in the right breast were
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judged to be suspicious, not very suspicious,
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but a little bit suspicious because they were new.
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And there was a little bit of
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an asymmetry along with them.
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So this was given a BI-RADS category four
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and bilateral biopsy was recommended.
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And when the biopsy was performed,
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the hypoechoic mass was invasive ductal
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carcinoma with ductal carcinoma in situ.
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So that's what made up the left breast asymmetry.
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And then the calcifications
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were benign on the right side.
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So that was coarse
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calcifications with fat necrosis.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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