Fig. 43.1 Sonography.

Clinical Findings

No findings at palpation. Sanguineous secretion from one duct of the left breast.

Fig. 43.2a,b Digital mammography and galactography of the left breast, CC view.

Fig. 43.3a,b Digital mammography and galactography of the left breast, ML view.

Fig. 43.4 Magnification view of galactography of the left breast (CC).

Fig. 43.5a-c Contrast-enhanced MR mammography.

Fig. 43.6a-c Contrast-enhanced MR mammography.

Fig. 43.7 Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 43.8 Signal-to-time curves of the lesion in the left breast.

Ultrasound

Following an ectatic duct in the lower inner quadrant of the left breast, ultrasound showed vague indications of a hypoechoicmass, 3 mm in diameter, with indeterminate distal signal behavior. US BI-RADS 3.

Mammography

Imaging showed inhomogeneous dense parenchyma, ACR type 3. There were no suspicious masses or densities, particularly in the lower inner quadrant of the left breast, and no microcalcifications. No architectural distortion. Galactography demonstrated a 3 mmcontrast-filling defect in the lower inner quadrant of the left breast. BI-RADS right 1/left 3. PGMI is not defined for unilateral imaging.

MR Mammography

Consistent with the lesion found in galactography, there was a hypervascularized, partially ill-defined lesion of 3 mm diameter in the lower inner quadrant of the left breast, with an increased signal in T2-weighted imaging. The lesion showed initial signal increase of 120% followed by washout.

MRI Artifact Category: 2

MRI Density Type: 1

Differential Diagnosis

Papilloma, adenoma, fibroadenoma, carcinoma.

Procedure

Fig. 43.10a First biopsy specimen containing a round nodular structure (arrow).

Fig. 43.10 b Complete set of 20 biopsy specimens ready for dispatch to histology lab.