43-year-old woman with diffuse left breast pain and palpable lump. Family history of breast cancer
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Our next patient is a 43-year-old
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woman with diffuse left breast pain and
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palpable lump with a family history of
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breast cancer in her mother at age 37.
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So for this patient, we performed
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a bilateral diagnostic mammogram.
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You have CC views back-to-back on the top
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of the screen and MLO views on the bottom.
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And you can see pretty clearly that
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there's a lot of asymmetric density in
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the left breast, maybe a little bit of
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skin thickening compared to the right.
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There's some large lymph nodes, certainly
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this one in the lower left axilla
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is large, and lots of density there.
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So we'll take a closer look.
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Here's the CC view and then tomosynthesis
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images through that CC view.
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It looks like there may be
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some masses here centrally.
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There's the nipple.
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Pull up the MLO view.
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You can see that asymmetric density,
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some skin thickening here, and a large lymph node.
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Here's the tomosynthesis image showing maybe
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some central masses and that large lymph node
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and certainly thick skin at the lower breast.
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So we went ahead and did ultrasound next.
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Skin is thick, there's some edema,
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kind of hypervascular, there's an
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area that looks more like a mass.
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So in this patient, it was a little bit
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unclear from her presentation whether she
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had diffuse mastitis or she had inflammatory
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breast cancer, and sometimes it can
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be a little bit unclear at the outset.
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There was a strong family history
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of breast cancer in this patient.
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Um, she had some other medical problems,
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but she was considered a high-risk person.
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So we didn't want to just,
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you know, say that this was mastitis.
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So our suggestion was a course of
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antibiotics, and that if she didn't improve
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on antibiotics, then we would perform
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a biopsy or some type of intervention.
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During the course of antibiotics,
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she became much more ill with fever and
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chills and ended up being admitted to
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the hospital for intravenous antibiotics.
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So this is a presumed case of diffuse
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mastitis, and, you know, we will follow up.
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Um, this is actually an active case and we'll
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follow up, and hopefully everything will resolve.
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But even if we are suspecting mastitis, but it's
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questionable, we would want to do a course of
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antibiotics and then follow up afterward,
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and just make sure that everything has resolved.
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If it hasn't, then we would
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certainly do a biopsy.
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We don't want to miss a case
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of inflammatory breast cancer.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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