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.
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
The next case is a 61-year-old woman with
0:03
a history of left breast DCIS 10 years ago,
0:07
and she's presenting for annual follow-up.
0:11
So these are the routine views for this patient.
0:14
She's had a lumpectomy on the left,
0:17
she's had excisional biopsy on the
0:19
right, so her scars are marked.
0:22
She's had biopsies bilaterally,
0:24
so there are biopsy clips in both breasts.
0:28
And what caught my eye here on the
0:31
left MLO view were these little areas
0:35
of asymmetry in the lower breast.
0:37
Her lumpectomy was in the upper breast.
0:41
So we looked through these areas with
0:44
tomosynthesis and it did look like indeed there
0:48
were some asymmetries, maybe masses there,
0:53
and those were new compared to a previous exam.
0:57
We did some extra work with spot
1:01
compression, you know, it definitely
1:03
looks like there were two masses there.
1:07
We thought on the CC view that
1:10
these were probably lateral.
1:13
Here's her lumpectomy site.
1:15
It's a little hard to see them.
1:17
I think maybe one of them is visible here.
1:21
Did a spot compression CC trying to find them.
1:25
I think we see one here.
1:28
She went from just an easy
1:30
follow-up the lumpectomy site to.
1:34
You know, a search for additional
1:36
masses that she hadn't had before.
1:41
This was her lateral view, and
1:44
we definitely thought there was
1:45
something here and probably here.
1:48
And we had similar views from the prior
1:50
study that definitely didn't show this.
1:52
You can see the distortion at her lumpectomy site.
1:55
You know, there's her scar marker,
1:58
that interrupted line on the skin,
2:00
and then there's, you know, underlying
2:02
distortion at the lumpectomy site.
2:04
So this is really a different part of the breast.
2:07
So we went ahead and looked with ultrasound,
2:10
and we found one mass that was sort of mixed
2:15
echotexture, hypoechoic and hyperechoic.
2:18
At the three o'clock position.
2:20
And then this at the four o'clock position, there
2:23
was an echogenic mass with some blood flow in it.
2:28
So these two areas were recommended for
2:30
biopsy and both had similar pathology.
2:35
It was invasive mammary carcinoma
2:37
with ductile and lobular features.
2:39
So she previously had had only
2:41
a ductile carcinoma in situ.
2:43
These were actually invasive cancers.
2:46
So this was a recurrence in the same breast.
61-year-old woman with history of left breast DCIS 10 years ago. Annual follow up
HIDEInteractive Transcript
0:00
The next case is a 61-year-old woman with
0:03
a history of left breast DCIS 10 years ago,
0:07
and she's presenting for annual follow-up.
0:11
So these are the routine views for this patient.
0:14
She's had a lumpectomy on the left,
0:17
she's had excisional biopsy on the
0:19
right, so her scars are marked.
0:22
She's had biopsies bilaterally,
0:24
so there are biopsy clips in both breasts.
0:28
And what caught my eye here on the
0:31
left MLO view were these little areas
0:35
of asymmetry in the lower breast.
0:37
Her lumpectomy was in the upper breast.
0:41
So we looked through these areas with
0:44
tomosynthesis and it did look like indeed there
0:48
were some asymmetries, maybe masses there,
0:53
and those were new compared to a previous exam.
0:57
We did some extra work with spot
1:01
compression, you know, it definitely
1:03
looks like there were two masses there.
1:07
We thought on the CC view that
1:10
these were probably lateral.
1:13
Here's her lumpectomy site.
1:15
It's a little hard to see them.
1:17
I think maybe one of them is visible here.
1:21
Did a spot compression CC trying to find them.
1:25
I think we see one here.
1:28
She went from just an easy
1:30
follow-up the lumpectomy site to.
1:34
You know, a search for additional
1:36
masses that she hadn't had before.
1:41
This was her lateral view, and
1:44
we definitely thought there was
1:45
something here and probably here.
1:48
And we had similar views from the prior
1:50
study that definitely didn't show this.
1:52
You can see the distortion at her lumpectomy site.
1:55
You know, there's her scar marker,
1:58
that interrupted line on the skin,
2:00
and then there's, you know, underlying
2:02
distortion at the lumpectomy site.
2:04
So this is really a different part of the breast.
2:07
So we went ahead and looked with ultrasound,
2:10
and we found one mass that was sort of mixed
2:15
echotexture, hypoechoic and hyperechoic.
2:18
At the three o'clock position.
2:20
And then this at the four o'clock position, there
2:23
was an echogenic mass with some blood flow in it.
2:28
So these two areas were recommended for
2:30
biopsy and both had similar pathology.
2:35
It was invasive mammary carcinoma
2:37
with ductile and lobular features.
2:39
So she previously had had only
2:41
a ductile carcinoma in situ.
2:43
These were actually invasive cancers.
2:46
So this was a recurrence in the same breast.
Report
Faculty
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
Tags
Women's Health
Ultrasound
Tomosynthesis
Neoplastic
Mammography
Breast
© 2024 Medality. All Rights Reserved.