38-year-old woman with left breast palpable lump and bilateral breast pain
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So we'll move on to our next case, which is a
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38-year-old woman with a palpable lump in the
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left breast and also bilateral breast pain.
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So here's the mammogram for our next patient.
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We have CC (craniocaudal) views on the top of the screen and
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bilateral MLO (mediolateral oblique) views on the bottom of the screen.
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Again, this is a palpable mass.
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So we have a triangular skin marker here on the
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left breast where the patient feels something.
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This patient is 38.
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You know, so like we said, for patients
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over age 30, we'll begin with a bilateral
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mammogram and then follow up with an
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ultrasound in the area of palpable concern.
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In this case, where our tissue is a little
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bit less dense than the previous case,
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and we can see in the area of palpable concern,
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it really just looks like there's some
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fatty tissue under that palpable marker.
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So we'll go through our images,
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um, with tomosynthesis as well.
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And here's our right CC view,
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really just normal-looking tissue there.
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This is our right MLO view, so
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normal tissue, nipple right there.
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We'll go to our left CC view.
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And as we scroll through,
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this looks pretty normal.
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We see that triangular skin marker
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here with really nothing under
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it, but normal-looking tissue.
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And then here's our left MLO view
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again, triangular skin marker, nipple
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here really looks pretty good.
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So we're not really seeing anything
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on this mammogram that's concerning.
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We're going to go ahead and do an
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ultrasound as well for this patient.
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So here's the ultrasound.
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She had some areas of pain that were bilateral.
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So we scanned the areas of pain as well.
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So you'll see some images
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that are labeled right breast.
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And nothing obvious in the areas
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of pain, just normal tissue.
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Left breast, she had some areas of pain also.
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And then in the palpable area,
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which was at the nine o'clock position,
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two centimeters from the nipple.
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Really, we just see normal
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appearing tissue and fatty tissue.
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And of course, we would have gone in and done
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a limited physical examination of that area
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and done a real-time re-evaluation of the area
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of palpable concern done by the radiologist
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with ultrasound and also saw nothing there.
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And just a word about ultrasound.
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You know, we want to be sure that we are
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annotating our images appropriately, so we'll do
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right or left breast, a clock position,
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distance from the nipple, in this case five centimeters
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from nipple, whether we're antiradial or
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radial, and then if there's an issue that we're
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specifically addressing pain or palpable lump,
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we'll actually annotate that on the image as well.
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So, another, uh, patient with essentially normal
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tissue, no finding to correlate with the palpable
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area or the pain, and everything looks normal.
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So in this case, we're going to, um, code
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this as a BI-RADS category one negative
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exam on both the mammogram and ultrasound.
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And then our recommendation is going
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to be that we're going to refer the
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patient back to their provider, um,
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for follow-up of the areas of concern.
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And then, uh, the patient.
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Assuming that she's of average risk
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for breast cancer, our screening
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mammograms would begin at age 40.
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So we put that in our
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recommendation section as well.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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