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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.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
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.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
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.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
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 case is a 55-year-old woman with redness
0:03
and thickening of the skin of the right breast.
0:07
So for this patient, we have CC (craniocaudal) views
0:08
at the top of your screen, MLO
0:11
MLO (mediolateral oblique) views at the bottom of the screen.
0:13
And you can see comparing one side to the
0:15
other that on the right side, we have diffuse
0:17
skin thickening, you know, particularly in
0:20
the anterior part of the breast compared
0:22
to the normal skin on the left side.
0:25
And there's a lot of asymmetric
0:26
tissue throughout this central breast.
0:29
No obvious mass there, but a lot of asymmetry,
0:32
and it looks like the nipple, at least on
0:34
the MLO view, is retracted or pulled inward.
0:39
So we'll take a look at those
0:40
images a little bit more closely.
0:42
Here's the full right CC view,
0:46
and when we image this a little bit closer
0:48
up, you can see that there are some
0:49
calcifications here in the central breast.
0:53
And we'll look at the
0:54
tomosynthesis images through this.
1:01
There's a lot of increased density
1:02
here, maybe a mass, and then
1:06
there's some calcifications as well.
1:11
Looks like there's probably a mass in here.
1:15
And then on the MLO view, you know,
1:19
we can see that the nipple is retracted
1:25
and the skin is really quite thick
1:28
anteriorly and in the inferior aspect,
1:32
and there's a lot of density there.
1:35
So our next step is going to
1:37
be to look with ultrasound.
1:39
I mean, we could get extra views of
1:41
this breast, spot compression images,
1:44
magnification views, but probably the
1:46
ultrasound is going to be the most helpful.
1:49
So here's our ultrasound.
1:51
And when we scan this, there's it's
1:55
thickening of the skin, and it looks like
1:58
there's a, a mass that's hard to even see.
2:02
We have this Sine image through it,
2:06
but there's a lot of shadowing and hypoechoic
2:09
tissue there in the central breast.
2:11
It's possible that this
2:12
entire area represents a mass.
2:16
It's certainly infiltrating through the tissue.
2:19
And this patient was not having
2:22
symptoms of mastitis, but the skin
2:26
was noted to be red and thick.
2:28
And then looking at the axilla,
2:30
there's an abnormal axillary lymph node with a
2:34
thick cortex, and another lymph node that
2:38
has a very thin cortex, but at least one
2:41
lymph node with a thick cortex there.
2:44
So in this situation, the thought was
2:48
that this represented an inflammatory
2:50
breast cancer rather than a mastitis.
2:52
And the recommendation was for biopsy
2:55
of the mass area in the right central
2:58
breast and also ultrasound-guided
3:01
biopsy of the thickened lymph node.
3:04
And this was categorized as BI-RADS category
3:07
five, highly suggestive of malignancy.
3:11
And, um, the biopsy.
3:13
Returned poorly differentiated
3:15
infiltrating ductal carcinoma and
3:17
metastatic disease in the lymph node.
55-year-old woman with skin thickening and redness in right breast
HIDEInteractive Transcript
0:00
Our next case is a 55-year-old woman with redness
0:03
and thickening of the skin of the right breast.
0:07
So for this patient, we have CC (craniocaudal) views
0:08
at the top of your screen, MLO
0:11
MLO (mediolateral oblique) views at the bottom of the screen.
0:13
And you can see comparing one side to the
0:15
other that on the right side, we have diffuse
0:17
skin thickening, you know, particularly in
0:20
the anterior part of the breast compared
0:22
to the normal skin on the left side.
0:25
And there's a lot of asymmetric
0:26
tissue throughout this central breast.
0:29
No obvious mass there, but a lot of asymmetry,
0:32
and it looks like the nipple, at least on
0:34
the MLO view, is retracted or pulled inward.
0:39
So we'll take a look at those
0:40
images a little bit more closely.
0:42
Here's the full right CC view,
0:46
and when we image this a little bit closer
0:48
up, you can see that there are some
0:49
calcifications here in the central breast.
0:53
And we'll look at the
0:54
tomosynthesis images through this.
1:01
There's a lot of increased density
1:02
here, maybe a mass, and then
1:06
there's some calcifications as well.
1:11
Looks like there's probably a mass in here.
1:15
And then on the MLO view, you know,
1:19
we can see that the nipple is retracted
1:25
and the skin is really quite thick
1:28
anteriorly and in the inferior aspect,
1:32
and there's a lot of density there.
1:35
So our next step is going to
1:37
be to look with ultrasound.
1:39
I mean, we could get extra views of
1:41
this breast, spot compression images,
1:44
magnification views, but probably the
1:46
ultrasound is going to be the most helpful.
1:49
So here's our ultrasound.
1:51
And when we scan this, there's it's
1:55
thickening of the skin, and it looks like
1:58
there's a, a mass that's hard to even see.
2:02
We have this Sine image through it,
2:06
but there's a lot of shadowing and hypoechoic
2:09
tissue there in the central breast.
2:11
It's possible that this
2:12
entire area represents a mass.
2:16
It's certainly infiltrating through the tissue.
2:19
And this patient was not having
2:22
symptoms of mastitis, but the skin
2:26
was noted to be red and thick.
2:28
And then looking at the axilla,
2:30
there's an abnormal axillary lymph node with a
2:34
thick cortex, and another lymph node that
2:38
has a very thin cortex, but at least one
2:41
lymph node with a thick cortex there.
2:44
So in this situation, the thought was
2:48
that this represented an inflammatory
2:50
breast cancer rather than a mastitis.
2:52
And the recommendation was for biopsy
2:55
of the mass area in the right central
2:58
breast and also ultrasound-guided
3:01
biopsy of the thickened lymph node.
3:04
And this was categorized as BI-RADS category
3:07
five, highly suggestive of malignancy.
3:11
And, um, the biopsy.
3:13
Returned poorly differentiated
3:15
infiltrating ductal carcinoma and
3:17
metastatic disease in the lymph node.
Report
Faculty
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
Tags
Women's Health
Ultrasound
Tomosynthesis
Neoplastic
Mammography
Breast
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