Wk 5, Case 4 - Review

HISTORY: 58 year old woman status post remote bilateral implants with newly diagnosed right breast DCIS and papillomas presented for extent of disease

Summary of prior imaging:

Mammography: Bilateral silicone implants and developing asymmetry RLOQ
Ultrasound: Ductal dilation and multifocal intraductal masses right breast middle depth RLOQ
Breast MRI: None

FINDINGS

Quality control issues: ☐None ☐Poor/lack contrast bolus ☒Poor fat suppression [Sag T1 Fat Sat sequence on right] ☐Susceptibility ☐Movement ☐Other

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

LEFT BREAST

Narrative
Status post left retroglandular silicone breast implant with intracapsular rupture. No suspicious enhancing masses or areas of non-mass enhancement. No axillary or internal mammary adenopathy is seen. No abnormal skin or pectoralis muscle enhancement.

Left breast lesion 1
Lesion type: Choose an item.

Longest measurement cm. Choose an item Quadrant. Choose an item. Radian. dist from nipple cm from the nipple

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

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 in the skin

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

Lymph nodes LEFT: ☒Normal axillary, ☐Signal void from clips, ☐Abnormal axillary, ☐Abnormal internal mammary

RIGHT BREAST

Narrative
Status post right retroglandular silicone breast implant with intracapsular and extracapsular rupture. 10 cm span of lower outer quadrant ductal T2 and T1 bright signal extending toward the nipple, some of which enhances on delayed imaging in persistent pattern, with biopsy cavity seen. No suspicious enhancing masses. No axillary or internal mammary adenopathy is seen. No abnormal skin or pectoralis muscle enhancement.

Right breast lesion 1
Lesion type: Non-mass enhancement
6.5 cm. Lower outer Quadrant. 7:00 Radian. Pointing toward and away from the nipple

BI-RADS: 6: Known biopsy-proven malignancy: Surgical excision when clinically appropriate

Associated findings RIGHT: ☒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: ☐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, ☐ Abnormal internal mammary

Extramammary findings: None

SUMMARY: Biopsy-proven DCIS and papillomas right breast. Bilateral ruptured silicone implants

LEFT BI-RADS: 2: Negative
RIGHT BI-RADS: 6: Known biopsy-proven malignancy: Surgical excision when clinically appropriate

RECOMMENDATIONS: Surgical excision when clinically appropriate