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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
Our next patient is a 43-year-old
0:03
woman with diffuse left breast pain and
0:05
palpable lump with a family history of
0:07
breast cancer in her mother at age 37.
0:11
So for this patient, we performed
0:13
a bilateral diagnostic mammogram.
0:16
You have CC views back-to-back on the top
0:18
of the screen and MLO views on the bottom.
0:21
And you can see pretty clearly that
0:24
there's a lot of asymmetric density in
0:26
the left breast, maybe a little bit of
0:28
skin thickening compared to the right.
0:30
There's some large lymph nodes, certainly
0:33
this one in the lower left axilla
0:35
is large, and lots of density there.
0:39
So we'll take a closer look.
0:42
Here's the CC view and then tomosynthesis
0:47
images through that CC view.
0:51
It looks like there may be
0:52
some masses here centrally.
0:55
There's the nipple.
0:59
Pull up the MLO view.
1:02
You can see that asymmetric density,
1:04
some skin thickening here, and a large lymph node.
1:10
Here's the tomosynthesis image showing maybe
1:14
some central masses and that large lymph node
1:19
and certainly thick skin at the lower breast.
1:25
So we went ahead and did ultrasound next.
1:31
Skin is thick, there's some edema,
1:36
kind of hypervascular, there's an
1:40
area that looks more like a mass.
1:42
So in this patient, it was a little bit
1:45
unclear from her presentation whether she
1:48
had diffuse mastitis or she had inflammatory
1:54
breast cancer, and sometimes it can
1:57
be a little bit unclear at the outset.
1:59
There was a strong family history
2:01
of breast cancer in this patient.
2:03
Um, she had some other medical problems,
2:05
but she was considered a high-risk person.
2:07
So we didn't want to just,
2:08
you know, say that this was mastitis.
2:10
So our suggestion was a course of
2:13
antibiotics, and that if she didn't improve
2:15
on antibiotics, then we would perform
2:18
a biopsy or some type of intervention.
2:21
During the course of antibiotics,
2:23
she became much more ill with fever and
2:26
chills and ended up being admitted to
2:29
the hospital for intravenous antibiotics.
2:32
So this is a presumed case of diffuse
2:36
mastitis, and, you know, we will follow up.
2:39
Um, this is actually an active case and we'll
2:43
follow up, and hopefully everything will resolve.
2:46
But even if we are suspecting mastitis, but it's
2:49
questionable, we would want to do a course of
2:52
antibiotics and then follow up afterward,
2:56
and just make sure that everything has resolved.
2:58
If it hasn't, then we would
3:00
certainly do a biopsy.
3:02
We don't want to miss a case
3:03
of inflammatory breast cancer.
43-year-old woman with diffuse left breast pain and palpable lump. Family history of breast cancer
HIDEInteractive Transcript
0:00
Our next patient is a 43-year-old
0:03
woman with diffuse left breast pain and
0:05
palpable lump with a family history of
0:07
breast cancer in her mother at age 37.
0:11
So for this patient, we performed
0:13
a bilateral diagnostic mammogram.
0:16
You have CC views back-to-back on the top
0:18
of the screen and MLO views on the bottom.
0:21
And you can see pretty clearly that
0:24
there's a lot of asymmetric density in
0:26
the left breast, maybe a little bit of
0:28
skin thickening compared to the right.
0:30
There's some large lymph nodes, certainly
0:33
this one in the lower left axilla
0:35
is large, and lots of density there.
0:39
So we'll take a closer look.
0:42
Here's the CC view and then tomosynthesis
0:47
images through that CC view.
0:51
It looks like there may be
0:52
some masses here centrally.
0:55
There's the nipple.
0:59
Pull up the MLO view.
1:02
You can see that asymmetric density,
1:04
some skin thickening here, and a large lymph node.
1:10
Here's the tomosynthesis image showing maybe
1:14
some central masses and that large lymph node
1:19
and certainly thick skin at the lower breast.
1:25
So we went ahead and did ultrasound next.
1:31
Skin is thick, there's some edema,
1:36
kind of hypervascular, there's an
1:40
area that looks more like a mass.
1:42
So in this patient, it was a little bit
1:45
unclear from her presentation whether she
1:48
had diffuse mastitis or she had inflammatory
1:54
breast cancer, and sometimes it can
1:57
be a little bit unclear at the outset.
1:59
There was a strong family history
2:01
of breast cancer in this patient.
2:03
Um, she had some other medical problems,
2:05
but she was considered a high-risk person.
2:07
So we didn't want to just,
2:08
you know, say that this was mastitis.
2:10
So our suggestion was a course of
2:13
antibiotics, and that if she didn't improve
2:15
on antibiotics, then we would perform
2:18
a biopsy or some type of intervention.
2:21
During the course of antibiotics,
2:23
she became much more ill with fever and
2:26
chills and ended up being admitted to
2:29
the hospital for intravenous antibiotics.
2:32
So this is a presumed case of diffuse
2:36
mastitis, and, you know, we will follow up.
2:39
Um, this is actually an active case and we'll
2:43
follow up, and hopefully everything will resolve.
2:46
But even if we are suspecting mastitis, but it's
2:49
questionable, we would want to do a course of
2:52
antibiotics and then follow up afterward,
2:56
and just make sure that everything has resolved.
2:58
If it hasn't, then we would
3:00
certainly do a biopsy.
3:02
We don't want to miss a case
3:03
of inflammatory breast cancer.
Report
Faculty
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
Tags
Women's Health
Ultrasound
Tomosynthesis
Non-infectious Inflammatory
Mammography
Breast
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