Reduction Mammoplasty

2018 ◽  
Author(s):  
Laura J. Horvath
Keyword(s):  
Breast Imaging ◽  
Reduction Mammoplasty ◽  
Screening Mammography ◽  
Breast Size ◽  
Fat Necrosis ◽  
Imaging Studies ◽  
Breast Parenchyma ◽  
Imaging Protocols ◽  
History Of ◽  
Management Recommendations

Reduction mammoplasty is a surgical procedure performed to decrease breast size. Breast parenchyma and skin are resected, and the nipple is repositioned to a more superior location on the smaller breast mound. The goals of the procedure are to alleviate a variety of physical and psychological complaints. Because women with a history of reduction surgery are commonly seen for screening mammography and other breast imaging studies, it is important to be aware of the normal post-operative appearance. This chapter, appearing in the section on intervention and surgical change, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for reduction mammoplasty. Topics discussed include clinical indications, surgical technique, and benign post-operative changes, including scars, oil cysts, fat necrosis, and calcifications.

Vascular Calcifications

2018 ◽  
Author(s):  
Anna I. Holbrook
Keyword(s):  
Cardiovascular Disease ◽  
Renal Disease ◽  
Blood Vessels ◽  
Arterial Wall ◽  
Imaging Features ◽  
Artery Wall ◽  
Vascular Calcifications ◽  
Imaging Protocols ◽  
History Of ◽  
Management Recommendations

Vascular calcifications lie within the artery wall, and appear to be linear, usually in association with blood vessels. The parallel or “tram-track” appearance of the calcifications in opposite walls of the artery is pathognomonic. They are more prevalent with age. They are also associated with diabetes, renal disease, hyperparathyroidism, parity, and history of lactation, and possibly, cardiovascular disease. Vascular calcifications in the breast are within the arterial wall media, where they are known as Mönckeberg medial calcific sclerosis. This chapter reviews the key imaging features, imaging protocols, differential diagnoses, and management recommendations for vascular calcifications. Topics discussed include demographics and comorbidities, linear calcifications, and diagnostic workup.

Architectural Distortion (Cancer)

2018 ◽  
Author(s):  
Melissa A. Durand
Keyword(s):  
Breast Tissue ◽  
False Negative ◽  
Architectural Distortion ◽  
Breast Parenchyma ◽  
Mammographic Finding ◽  
Mass Asymmetry ◽  
Imaging Protocols ◽  
Primary Finding ◽  
High Positive Predictive Value ◽  
Management Recommendations

An architectural distortion (AD) is an alteration of the breast parenchyma, which results in radiating lines or spicules emanating from a point without a distinct mass. It can occur as the primary finding, or it may be an associated feature of a mass, asymmetry, or calcifications. AD is a mammographic finding with a high positive predictive value for malignancy and is a major cause of false-negative screening exams. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols, differential diagnoses, management recommendations, and potential pitfalls for a malignant architectural distortion. Topics discussed include superimposition of breast tissue, localization, workup of tomosynthesis-detected architectural distortion, and image-guided biopsy options.

Dystrophic Calcifications

2018 ◽  
Author(s):  
Anna I. Holbrook
Keyword(s):  
Clinical Features ◽  
Radiation Treatment ◽  
Differential Diagnoses ◽  
Architectural Distortion ◽  
Fat Necrosis ◽  
Surgical Clips ◽  
Imaging Protocols ◽  
Skin Retraction ◽  
Management Recommendations

Dystrophic calcifications are typically large (usually >1 mm), coarse, irregular or plaque-like and associated with lucent centers. They also may be thin, smooth, and round or oval, with lucent centers, called “rim” (previously also known as “eggshell”) calcifications. They form in response to trauma, including surgery or irradiation. They can be seen in association with other findings of breast trauma, including surgical clips, architectural distortion, skin retraction, skin thickening, oil cysts, or trabecular thickening. This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols, differential diagnoses, and management recommendations for dystrophic calcifications. Topics discussed include findings after breast trauma or surgery/radiation treatment and the evolution of fat necrosis.

Fat-Containing, Circumscribed Mass(es)

2018 ◽  
Author(s):  
Diana L. Lam ◽  
John R. Scheel
Keyword(s):  
Lymph Node ◽  
Imaging Features ◽  
Atypical Presentation ◽  
Fat Necrosis ◽  
Lipomatous Tumor ◽  
Large Size ◽  
Imaging Protocols ◽  
Steatocystoma Multiplex ◽  
Well Differentiated ◽  
Management Recommendations

The majority of fat-containing masses are asymptomatic, but can present as painless, soft, mobile masses. A fat-containing mass within the breast is a benign finding, with the exception of the rare liposarcoma. The differential in non-lactating woman includes a lipoma, hamartoma, lymph node, and fat necrosis. Any atypical presentation of a fat-containing mass (such as thick, nodular septation or capsule, large size >10 cm, a mass that is clinically increasing in size) should raise suspicion for a rare fat-containing tumor such as an atypical lipomatous tumor or well-differentiated liposarcoma. This chapter reviews the key clinical and imaging features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for a fat-containing, circumscribed mass. Topics discussed include lipomas, hamartomas, oil cysts, fat necrosis, and steatocystoma multiplex. Fat-containing lesions in the setting of lactation (galactocoele) as well as intramammary lymph nodes are discussed in separate chapters.

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.

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.

Mass in Lactating Female

2018 ◽  
Author(s):  
Nina Woldenberg ◽  
Melissa M. Joines
Keyword(s):  
Breast Cancer ◽  
Clinical Features ◽  
Screening Mammography ◽  
Accurate Diagnosis ◽  
Comprehensive Understanding ◽  
Palpable Mass ◽  
Imaging Protocols ◽  
Fibrocystic Change ◽  
Lactating Breast ◽  
Management Recommendations

Timely and accurate diagnosis of a mass in the lactating patient requires comprehensive understanding of the indicated imaging workup. During lactation it is not uncommon for patients to present with a palpable mass that requires evaluation. In patients with a palpable abnormality, diagnostic evaluation should not be delayed due to pregnancy or lactation. In addition, a mass that requires further evaluation may be identified at the time of screening mammography in lactating patients. 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 a mass in the lactating patient. Topics discussed include differential considerations of benign and malignant masses in the lactating breast including cysts, focal lobular hyperplasia (focal fibrocystic change), galactocele, abscess, fibroadenoma, lactating adenoma, and pregnancy-associated breast cancer.

Concordance of Breast Imaging Reporting and Data System Assessments and Management Recommendations in Screening Mammography

Radiology ◽  
2002 ◽  
Vol 222 (2) ◽  
pp. 529-535 ◽  
Author(s):  
Stephen H. Taplin ◽  
Laura E. Ichikawa ◽  
Karla Kerlikowske ◽  
Virginia L. Ernster ◽  
Robert D. Rosenberg ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Screening Mammography ◽  
Data System ◽  
Management Recommendations

Skin Lesions

2018 ◽  
Author(s):  
Phoebe E. Freer
Keyword(s):  
Breast Imaging ◽  
Locally Advanced ◽  
Skin Lesions ◽  
Screening Mammography ◽  
Imaging Features ◽  
Breast Cancers ◽  
Seborrheic Keratosis ◽  
Breast Parenchyma ◽  
Sebaceous Cyst ◽  
Inflammatory Component

Skin lesions are commonly seen on breast imaging. Often, a raised skin lesion is encountered incidentally during screening mammography and can be mistaken for a mass within the breast parenchyma. In most cases, lesions confined within the dermis are benign. Occasionally, focal skin involvement may be the presenting sign of a breast cancer that is either locally extensive to the skin or has an inflammatory component. This chapter reviews the key imaging and clinical features of skin lesions that may be encountered either incidentally on breast imaging or on diagnostic imaging as an area of patient concern. Imaging features of skin lesions, the differential diagnoses, and further management will be reviewed. Topics discussed include benign epithelial cysts (i.e., sebaceous cyst and epidermal inclusion cysts), seborrheic keratosis, keloid and dermal nevi, cellulitis, and inflammatory and locally advanced breast cancers.

Circumscribed Mass: Intramammary Lymph Node

2018 ◽  
Author(s):  
Mark D. Kettler
Keyword(s):  
Differential Diagnosis ◽  
Lymph Nodes ◽  
Breast Imaging ◽  
Three Dimensional ◽  
Screening Mammography ◽  
Imaging Features ◽  
Breast Masses ◽  
Intramammary Lymph Node ◽  
Management Recommendations ◽  
Do So

This chapter, appearing in the section on circumscribed mass, reviews the key clinical and imaging features, differential diagnosis, and management recommendations for intramammary lymph nodes. Benign intramammary lymph nodes are ubiquitous on screening mammography, and whenever it is possible to do so, they should be differentiated from solid masses in order to avoid unnecessary recalls for diagnostic imaging. Three-dimensional tomosynthesis can facilitate the diagnosis of benign intramammary lymph nodes and decrease the number of recalls for supplemental breast imaging. Ultrasound may help in distinguishing between benign lymph nodes and other breast masses when this cannot be accomplished by using mammography alone.

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