Fig. 38.1 a,b Digital mammography, CC view.

Clinical Findings

No findings.

Ultrasound

Unremarkable (not shown).

Fig. 38.2a,b Digital mammography, MLO view.

Fig. 38.3 Magnification view of the right breast.

Fig. 38.4a-c Contrast-enhanced MR mammography

Fig. 38.5a–c Contrast-enhanced MR mammography.

Fig. 38.6 Contrast-enhanced MR mammography. Maximum intensity projection.

Ultrasound

Particularly in the lower outer quadrant of the right breast, there were no findings consistent with the macro- and microcalcifications. US BI-RADS 1.

Mammography

Mammography showed bilaterally symmetric fibroglandular parenchyma, ACR type 2. Multiple monomorphous macrocalcifications were visible in regional distribution in the lower outer quadrant, close to the chest wall. There were no microcalcifications. Mammograms showed no mass or density and no architectural distortion. BI-RADS right 3/left 1. PGMI: CC view G (nipple not in profile); MLO view G (inframammary fold not correctly positioned; superimposition of abdominal wall on parenchyma).

MR Mammography

In precontrast Tl-weighted imaging, MRI documented an area near the chest wall of approx. 3 cm x 3 cm containing multiple foci up to 5 mm in diameter with hypointense signal. After administration of contrast there were individual enhancing spots within this area. Signal in T2-weighted imaging was increased. No other unusual findings.

MRI Artifact Category: 1

MRI Density Type: 1

Preliminary Diagnosis

Hematoma with calcifications.

Differential Diagnosis

Hamartoma, fat necrosis (previous trauma?), hemangioma, angiosarcoma.

Limit of the Requested Stereotactic Vacuum Core Biopsy

In this specific case the stereotactic table (manufacturer: Fischer Imaging) required the use of a diagonal needle angle, in the direction of the chest wall, to access findings close to the chest wall. Therefore, the requested stereotactic biopsy was not performed because of the risk of thoracic injury. At the patient’s request, and despite the BI-RADS 3 categorization of the mammography findings (because of the rare differential diagnosis of angiosarcoma), an open biopsy of this lesion was performed after hook-wire localization.

Macroscopic Findings

Fig. 38.7 Excised specimen.

Fig. 38.8 Specimen radiography.