Interactive Transcript
0:00
So we'll move on to our next case, which is a
0:03
38-year-old woman with a palpable lump in the
0:06
left breast and also bilateral breast pain.
0:10
So here's the mammogram for our next patient.
0:13
We have CC (craniocaudal) views on the top of the screen and
0:17
bilateral MLO (mediolateral oblique) views on the bottom of the screen.
0:20
Again, this is a palpable mass.
0:23
So we have a triangular skin marker here on the
0:26
left breast where the patient feels something.
0:29
This patient is 38.
0:31
You know, so like we said, for patients
0:32
over age 30, we'll begin with a bilateral
0:34
mammogram and then follow up with an
0:37
ultrasound in the area of palpable concern.
0:40
In this case, where our tissue is a little
0:42
bit less dense than the previous case,
0:45
and we can see in the area of palpable concern,
0:48
it really just looks like there's some
0:49
fatty tissue under that palpable marker.
0:53
So we'll go through our images,
0:56
um, with tomosynthesis as well.
1:00
And here's our right CC view,
1:07
really just normal-looking tissue there.
1:10
This is our right MLO view, so
1:13
normal tissue, nipple right there.
1:18
We'll go to our left CC view.
1:24
And as we scroll through,
1:26
this looks pretty normal.
1:28
We see that triangular skin marker
1:30
here with really nothing under
1:33
it, but normal-looking tissue.
1:37
And then here's our left MLO view
1:42
again, triangular skin marker, nipple
1:44
here really looks pretty good.
1:49
So we're not really seeing anything
1:51
on this mammogram that's concerning.
1:53
We're going to go ahead and do an
1:56
ultrasound as well for this patient.
1:58
So here's the ultrasound.
2:01
She had some areas of pain that were bilateral.
2:03
So we scanned the areas of pain as well.
2:05
So you'll see some images
2:06
that are labeled right breast.
2:14
And nothing obvious in the areas
2:17
of pain, just normal tissue.
2:19
Left breast, she had some areas of pain also.
2:24
And then in the palpable area,
2:26
which was at the nine o'clock position,
2:28
two centimeters from the nipple.
2:30
Really, we just see normal
2:32
appearing tissue and fatty tissue.
2:34
And of course, we would have gone in and done
2:36
a limited physical examination of that area
2:38
and done a real-time re-evaluation of the area
2:41
of palpable concern done by the radiologist
2:44
with ultrasound and also saw nothing there.
2:49
And just a word about ultrasound.
2:52
You know, we want to be sure that we are
2:54
annotating our images appropriately, so we'll do
2:57
right or left breast, a clock position,
3:00
distance from the nipple, in this case five centimeters
3:03
from nipple, whether we're antiradial or
3:06
radial, and then if there's an issue that we're
3:09
specifically addressing pain or palpable lump,
3:12
we'll actually annotate that on the image as well.
3:17
So, another, uh, patient with essentially normal
3:20
tissue, no finding to correlate with the palpable
3:23
area or the pain, and everything looks normal.
3:26
So in this case, we're going to, um, code
3:30
this as a BI-RADS category one negative
3:33
exam on both the mammogram and ultrasound.
3:36
And then our recommendation is going
3:38
to be that we're going to refer the
3:39
patient back to their provider, um,
3:42
for follow-up of the areas of concern.
3:45
And then, uh, the patient.
3:47
Assuming that she's of average risk
3:49
for breast cancer, our screening
3:51
mammograms would begin at age 40.
3:53
So we put that in our
3:54
recommendation section as well.
© 2024 MRI Online. All Rights Reserved.