HISTORY: 58 year old woman, high risk screening breast MRI, prior history of right breast invasive ductal cancer s/p right mastectomy and TRAM flap reconstruction 1 year prior to this MRI.
Summary of prior imaging:
Mammography: No right breast imaging after surgery. Left breast BI-RAD 1
Ultrasound: NA
Breast MRI: NA
FINDINGS
Quality control issues: ☒None ☐Poor/lack contrast bolus ☐Poor fat suppression
☐Susceptibility ☐Movement ☐Other
Background Parenchymal Enhancement: Moderate
Amount of Fibroglandular Tissue: Heterogenous glandular tissue
LEFT BREAST
Narrative: Scattered foci of enhancement consistent with fibrocystic/hormonal changes
Associated findings LEFT breast: ☐Nipple retraction, ☐Nipple involvement, ☐Skin
retraction, ☐Skin thickening, ☐Skin invasion-direct, ☐Skin invasion-inflammatory,
☐Pectoral muscle invasion, ☐Chest wall invasion, ☐ Architectural distortion
Non-enhancing findings LEFT breast: ☐High ductal signal pre contrast T1, ☐Cyst(s), ☐Hematoma/seroma, ☐Post therapy skin/trabecular thickening, ☐Non-enhancing mass, ☐Architectural distortion, ☐Signal void from clips
BI-RADS:2: Benign
Fat containing lesions LEFT: ☐Fat necrosis, ☐Hamartoma, ☐Post-operative
seroma/hematoma with fat
Lymph nodes LEFT: ☒Normal axillary, ☐Abnormal axillary, ☐ Abnormal internal mammary
RIGHT BREAST
Narrative: Post TRAM flap findings with skin thickening. Multiple areas of non-mass enhancement surrounding areas of fat consistent with fat necrosis.
Associated findings RIGHT breast: ☐Nipple retraction, ☐Nipple involvement, ☐Skin retraction, ☐Skin thickening, ☐Skin invasion-direct, ☐Skin invasion-inflammatory,☐Pectoral muscle invasion, ☐Chest wall invasion, ☐ Architectural distortion
Non-enhancing findings RIGHT breast: ☐High ductal signal pre contrast T1, ☐Cyst(s), ☐Hematoma/seroma, ☒Post therapy skin/trabecular thickening, ☐Non-enhancing mass, ☐Architectural distortion, ☐Signal void from clips
Fat containing lesions RIGHT: ☒Fat necrosis, ☐Hamartoma, ☐Post-operative
seroma/hematoma with fat
Lymph nodes RIGHT: ☒Normal axillary, ☐Abnormal axillary, ☐ Abnormal internal mammary
BI-RADS:2: Benign
Extramammary findings: None
SUMMARY: Extensive fat necrosis right breast following TRAM flap reconstruction. No evidence malignancy.
RECOMMENDATIONS: Continue annual high risk screening
