Nipple Discharge

2018 ◽  
Author(s):  
Nicole S. Winkler
Keyword(s):  
Lymph Nodes ◽  
Clinical Features ◽  
Nipple Discharge ◽  
Fluid Secretion ◽  
Clinical Implications ◽  
Imaging Findings ◽  
Fluid Content ◽  
Sonographic Evaluation ◽  
Imaging Protocols ◽  
Management Recommendations

Nipple discharge refers to expressible or spontaneous drainage of fluid from one or more duct orifices of the nipple. Discharge indicates excess fluid secretion into one or more ducts that will drain through an unobstructed duct orifice onto the nipple skin. The fluid content and appearance are important as they have clinical implications. Nipple discharge that is clear or bloody, unilateral (typically uniductal) and spontaneous (fluid discharges without breast or nipple compression) is considered suspicious for malignancy, though most cases are due to benign papillomas. This chapter, appearing in the section on nipple, skin and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for patients presenting with nipple discharge. Topics discussed include clinical evaluation of nipple discharge, sonographic evaluation of ducts and nipple, ductography, intraductal mass, and papilloma.

Duct Ectasia

2018 ◽  
Author(s):  
Nicole S. Winkler
Keyword(s):  
Lymph Nodes ◽  
Chronic Inflammation ◽  
Clinical Features ◽  
Nipple Discharge ◽  
Screening Mammography ◽  
Differential Diagnoses ◽  
Sonographic Evaluation ◽  
Imaging Protocols ◽  
Management Recommendations

Duct ectasia is a term used to describe benign dilation of fluid-filled mammary ducts. Duct ectasia is characterized by tubular fluid-filled structures >2 mm in diameter that are commonly bilateral and subareolar in location. Ductal dilation is due to weakened wall elasticity that occurs with age. The ducts fill with secretions that may result in intermittent nipple discharge or chronic inflammation. When duct ectasia involves multiple ducts bilaterally, it can be dismissed on screening mammography; however, a solitary dilated duct should be further evaluated, given the potential for associated non-calcified DCIS. This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for duct ectasia. Topics discussed include solitary dilated duct, nipple discharge, and sonographic evaluation of ducts.

Intracystic/Intraductal Mass

2018 ◽  
Author(s):  
Nicole S. Winkler
Keyword(s):  
Lymph Nodes ◽  
Papillary Carcinoma ◽  
Clinical Features ◽  
Nipple Discharge ◽  
Differential Diagnoses ◽  
Imaging Findings ◽  
Solid Mass ◽  
Common Cause ◽  
Imaging Protocols ◽  
Management Recommendations

This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for intracystic and intraductal masses. The differential diagnoses of intraductal and intracystic masses are similar, with papilloma the most common cause for both. Therefore, we review descriptive terms for both together, with similar implications and management recommendations. Intracystic masses have a higher association with malignancy than intraductal masses, due in part to overlap of imaging appearances of intracystic mass and complex cystic and solid mass. Topics discussed include intraductal and intracystic masses, evaluation of ducts, papilloma, papillary carcinoma and nipple discharge.

Nipple Abnormalities

2018 ◽  
Author(s):  
Nicole S. Winkler
Keyword(s):  
Inflammatory Response ◽  
Lymph Nodes ◽  
Clinical Features ◽  
Ductal Carcinoma ◽  
Imaging Features ◽  
Malignant Cells ◽  
Imaging Findings ◽  
Paget Disease ◽  
Imaging Protocols ◽  
Management Recommendations

New nipple retraction and new nipple inversion can be secondary to malignancy, post-surgical change, inflammation, or infection. Paget disease of the nipple is characterized by an inflammatory response of the nipple epidermis to malignant cells extending from ductal carcinoma in the lactiferous sinus. A mass arising within the nipple is rare and usually a variant of a papilloma arising in the nipple (nipple adenoma). This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for patients presenting with nipple retraction. Topics discussed include imaging features of nipple retraction, both benign and malignant causes of nipple retraction, Paget disease of the nipple, and masses occurring in the nipple.

Multiple Circumscribed Masses

2018 ◽  
Author(s):  
Erin L. Prince ◽  
Heidi R. Umphrey
Keyword(s):  
Lymph Nodes ◽  
Clinical Features ◽  
Clinical Information ◽  
Differential Diagnoses ◽  
Surrounding Tissue ◽  
Imaging Protocols ◽  
Screening Mammograms ◽  
Management Recommendations

A circumscribed mass is a mass with margins demonstrating a sharp demarcation between the lesion and surrounding tissue. On mammography, at least 75% of the margin must be well defined in order for the mass to qualify as circumscribed. Multiple circumscribed masses may be seen unilaterally or bilaterally and can be seen on up to 1.7% of screening mammograms. After mammography, these masses may need to be further evaluated with ultrasound and correlated with clinical information. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for multiple circumscribed masses. Topics discussed include cysts, fibroadenomas, oil cysts, metastases, lymph nodes, and neurofibromas.

Breast Implants

2018 ◽  
Author(s):  
Nanette D. DeBruhl ◽  
Nazanin Yaghmai
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Features ◽  
Breast Implants ◽  
Screening Mammography ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Imaging Protocols ◽  
Age Appropriate ◽  
Management Recommendations

The presence of breast implants limits the amount of tissue that can be visualized on mammography and tomosynthesis. The proper mammographic positioning of the breasts of women with implants requires special training. More tissue can be visualized in women with sub-pectoral implants than in women with sub-glandular implants. Women with implants are recommended to have age-appropriate routine interval screening mammography for detection of cancer. If an implant rupture is suspected, ultrasound and MRI are used as adjunct imaging modalities. This chapter, appearing in the section on breast implants, reviews the key imaging and clinical features, imaging protocols and pitfalls, and management recommendations for breast implants. Topics discussed include types of implants, imaging findings of intact implants, and signs of ruptured implants, using mammography, ultrasound, and magnetic resonance imaging.

Non-Mass Enhancement on MRI

2018 ◽  
Author(s):  
Diana L. Lam ◽  
Habib Rahbar
Keyword(s):  
Breast Cancer ◽  
Clinical Features ◽  
Morphological Features ◽  
Post Contrast ◽  
Imaging Protocols ◽  
Background Parenchymal Enhancement ◽  
Management Recommendations ◽  
Normal Background ◽  
Mass Enhancement ◽  
Parenchymal Enhancement

Breast cancer presents on MRI as an enhancing finding on post-contrast T1-weighted images that is distinct from normal background parenchymal enhancement (BPE), and these enhancing lesions can be further described as a focus, mass, or non-mass enhancement (NME). Each enhancing lesion, with the exception of a focus, can be described further with specific morphological features that are defined by the ACR BI-RADS Atlas. This chapter reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations of a focus of enhancement and non-mass enhancement on MRI. Topics discussed include distinguishing a focus from normal BPE, benign versus suspicious features of a focus, NME characterization, and kinetic enhancement curves.

Enhancing Mass on MRI

2018 ◽  
Author(s):  
John R. Scheel ◽  
Diana L. Lam
Keyword(s):  
Clinical Features ◽  
Irregular Shape ◽  
Differential Diagnoses ◽  
Imaging Protocols ◽  
Enhancement Curve ◽  
Rim Enhancement ◽  
Management Recommendations ◽  
Space Occupying Lesion

The ACR BI-RADS Atlas defines a “mass” on MRI as a space-occupying lesion with convex borders. Masses are characterized by their morphology and their internal enhancement characteristics. Mass morphology descriptor categories include shape (oval, round, irregular), margins (circumscribed, irregular, spiculated), and internal enhancement (homogeneous, heterogeneous, rim enhancement, dark internal septations). Suspicious morphology descriptors of MRI masses include irregular shape, irregular or spiculated margins, and heterogeneous internal enhancement. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols, differential diagnoses, and management recommendations for an enhancing mass on MRI. Topics discussed include characteristics of benign and malignant masses, classic benign masses, and enhancement curve assessment.

Spiculated Masses

2018 ◽  
Author(s):  
Liva Andrejeva ◽  
Jaime L. Geisel ◽  
Malini Harigopal
Keyword(s):  
Differential Diagnosis ◽  
Tumor Cells ◽  
Clinical Features ◽  
Clinical Management ◽  
Normal Tissue ◽  
Clinical History ◽  
Benign Lesions ◽  
Imaging Protocols ◽  
Malignant Lesions ◽  
Management Recommendations

A spiculated mass is a centrally dense lesion seen on mammography with sharp lines radiating from its margin. The spicules can vary greatly in length, from a few millimeters to several centimeters. In malignant lesions, spicules represent a mixture of tumor cells and fibrosis invading the normal tissue surrounding the lesion. Although a spiculated mass is thought of as a classic finding of malignancy on mammography, ultrasound, and MRI, its differential diagnosis includes benign lesions. However, unless clinical history strongly supports a benign diagnosis, a spiculated mass on any modality typically will require additional workup and biopsy. This chapter reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, radiology–pathology correlations, and clinical management recommendations for a spiculated mass. Topics discussed include both malignant and benign masses.

Mass with Indistinct Margins

2018 ◽  
Author(s):  
Lonie R. Salkowski
Keyword(s):  
Clinical Features ◽  
Differential Diagnoses ◽  
Imaging Protocols ◽  
Management Recommendations ◽  
Entire Margin

Masses described as having indistinct margins lack a clear demarcation of a portion or the entire margin from the surrounding tissues. The indistinctness of the margin raises the possibility of infiltration; therefore, this descriptor implies suspicion for malignancy. “Indistinct” differs from “obscured.” A mass with obscured margins insinuates that the surrounding tissues masks or covers the presence of the lesion. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for masses with indistinct margins. Topics discussed include differentiation of the mass with indistinct margins from an obscured mass and focal asymmetry, and how the presence of adjacent features can increase the suspicion of the mass with indistinct margins.

Mass in Male (Gynecomastia, Cancer)

2018 ◽  
Author(s):  
Eric Foo ◽  
Bonnie N. Joe
Keyword(s):  
Breast Cancer ◽  
Breast Tissue ◽  
Nipple Discharge ◽  
Male Breast ◽  
Differential Diagnoses ◽  
Benign Condition ◽  
Imaging Protocols ◽  
Management Recommendations

Gynecomastia is a benign condition manifesting as enlarged breasts in men and boys. This increased breast tissue is caused by excess fibroglandular deposits and is caused by hormonal imbalances, commonly due to estrogen excess or from various drugs, such as spironolactone, ketoconazole, cimetidine, ranitidine, and specific HIV therapies. Patients generally present with bilateral subareolar enlarged breasts (however, unilateral gynecomastia also occurs), which commonly exhibit tenderness on palpation, swelling, palpable lumps, or nipple discharge. This chapter reviews the important imaging protocols, pitfalls, differential diagnoses, radiology–pathology correlation, and management recommendations for gynecomastia and cancer of the male breast. Topics discussed include gynecomastia, breast cancer, pseudogynecomastia, hypogonadism, and lymphangioma.

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