Wk 4, Case 1 - Review

HISTORY: 55-year-old woman with a history of right breast lumpectomy and axillary surgery and left breast reduction presenting with a 6 month history of diffuse right breast swelling.

Summary of prior imaging:

Mammography: Recent diagnostic mammogram demonstrates postoperative findings in the right breast, and diffuse skin thickening.
Ultrasound: Ultrasound of the right breast demonstrates skin thickening and no underlying abnormality.
Breast MRI: NA

FINDINGS

Quality control issues: ☒None ☐Poor/lack contrast bolus ☐Poor fat suppression
☐Susceptibility ☐Movement ☐Other

Background Parenchymal Enhancement: Mild Amount of Fibroglandular Tissue: Scattered fibroglandular tissue

LEFT BREAST

Narrative: There are postoperative findings compatible with the clinical history of breast reduction. There is no suspicious enhancement or lymphadenopathy.

Associated findings LEFT: ☒NONE, ☐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: ☐NONE, ☐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 LEFT: ☐NONE, ☐Fat necrosis, ☐Hamartoma, ☐Post-operative seroma/hematoma with fat

Lymph nodes LEFT: ☒Normal axillary, ☐Abnormal axillary, ☐ Abnormal internal mammary

RIGHT BREAST
Narrative: There is a 6.8 cm (CC) fat containing mass in the right breast at the 8-9 o’clock position, a finding most compatible with postoperative fat necrosis. There are postoperative findings in the right axilla compatible with prior axillary dissection. There is diffuse skin thickening throughout the right breast. There is no suspicious enhancement or
lymphadenopathy.

Associated findings RIGHT breast: ☐NONE, ☐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: ☐NONE, ☐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: ☐NONE, ☒Fat necrosis, ☐Hamartoma, ☐Post-operative seroma/hematoma with fat

Lymph nodes RIGHT: ☐Normal axillary, ☐Abnormal axillary: description, ☐ Abnormal internal mammary: description

Extramammary findings: None

SUMMARY: Benign postoperative findings in the right breast compatible with prior lumpectomy and axillary dissection. There is diffuse skin thickening throughout the right breast. Given the finding of right axillary dissection, this finding is most compatible with lymphedema.

LEFT BI-RADS: 2: Benign: Routine breast MRI screening if cumulative lifetime risk =>20%
RIGHT BI-RADS: 2: Benign: Routine breast MRI screening if cumulative lifetime risk =>20%

RECOMMENDATIONS: Clinical follow up for right breast lymphedema is recommended. Also recommend routine screening mammography.