Case 30
Indication: Mastitis in upper outer quadrant of left breast, not responding to antibiotic therapy.
History: Open biopsy of abscess after puerperal mastitis and two relapses.
Risk profile: No increased risk.
Age: 34 years.
Fig. 30.1 a,b Ultrasound.
Fig. 30.2a,b Digital mammography, CC view
Clinical Findings
Painful 2 cm resistance in the upper outer quadrant of the left breast, near the nipple. No redness.
Fig. 30.3a,b Digital mammography, MLO view.
Fig. 30.4a–c Contrast-enhanced MRI of the breasts.
Fig. 30.5a–c Contrast-enhanced MRI of the breasts.
Fig. 30.6 Contrast-enhanced MR mammography. Maximum intensity projection.
Fig. 30.7a,b Signal-to-time curves.
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Please characterize ultrasound, mammography, and MRI findings.
What is your preliminary diagnosis?
What are your next steps? |
These are the imaging studies of a symptomatic woman presenting with a resistance and repeated inflammation of the left breast. Mastitis currently being treated with penicillin.
Ultrasound
Corresponding to the palpable resistance there was a circumscribed lesion of 1.2 cm diameter with inhomogeneous acoustic signal. This region showed a distal echo increase. US BI-RADS 3.
Mammography
Mammograms demonstrated a partially extremely dense parenchyma (ACR type 4). There was a slightly increased density of the left breast and a skin thickening of the left areola. Mammography showed no circumscribed densities or masses and no architectural distortion (BI-RADS right 1/left 3). PGMI: MLO view G (incomplete depiction of the inframammary fold); CC view P.
MR Mammography
In the upper outer quadrant of the left breast-corresponding to the changes found at clinical, mammographic and ultrasound examination-MRI depicted a 3 cm x 1.2 cm tubular lesion with hypervascularization of the wall. The central components of this lesion showed high signal in T2-weighted imaging and did not enhance. No findings of note in the right breast.
MRI Artifact Category: 2
MRI Density Type: 2
Preliminary Diagnosis
