ТОП просматриваемых книг сайта:
Breast Imaging. Beverly Hashimoto
Читать онлайн.Название Breast Imaging
Год выпуска 0
isbn 9781604064452
Автор произведения Beverly Hashimoto
Жанр Медицина
Издательство Ingram
Ultrasound
Frequency
• 10 MHz
Mass
• margin: well defined
• echogenicity: isoechoic
• retrotumoral acoustic appearance: single edge shadowing
• shape: ellipsoid (Fig. 1–2)
Figure 1–2. Left radial breast sonogram: The mammographic mass identified in Figure 1–1 corresponds to a well-defined mass with heterogeneous echogenicity. Milky fluid was aspirated from this mass.
Pathology
• galactocele
Management
• BI-RADS Assessment Category 2, benign finding
Pearls and Pitfalls
1. Galactoceles are benign milk-filled cysts. This lesion is generally discovered either during or shortly after lactation. Mammographically, galactoceles are well defined, oval, and may appear completely fat density, heterogeneous density, or equal density to glandular parenchyma.
2. Sonographically, galactoceles are hypoechoic, isoechoic, or heterogeneous in echogenicity. Fluid debris levels may be present.
Suggested Readings
1. Salvador R, Salvador M, Jimenez JA, et al. Galactocele of the breast: radiologic and ultrasonographic findings. Br J Radiol 1990;63:140–142.
2. Jackson VP, Jahan R, Fu YS. Benign breast lesions. In: Bassett LW, Jackson VP, Jahan R, Fu YS, Gold RH, eds. Diagnosis of Diseases of the Breast. Philadelphia: WB Saunders Company; 1997:357–443.
Case 2
Case History
A 39-year-old woman with new left breast lump. Left breast sonography is initially performed. As a result of the sonogram, a mammogram has been done.
Physical Examination
• left breast: 5 cm palpable lump in the upper inner quadrant
• right breast: normal exam
Mammogram
Mass (Fig. 2–1)
• margin: circumscribed
• shape: oval
• density: fat-containing
Figure 2–1. At the 9:00 position of the left breast, there is a well-defined oval fat-containing mass with heterogeneous density (arrows). (A). Left MLO mammogram. (B). Left CC mammogram.
Ultrasound
Frequency
• 10 MHz
Mass
• margin: well defined
• echogenicity: heterogeneous
• retrotumoral acoustic appearance: no shadowing
• shape: ellipsoid (Fig. 2–2)
Figure 2–2. Left radial breast sonogram: The palpable lump corresponds to a well-defined, oval, solid mass of heterogeneous echogenicity. The peripheral portion of this mass is isoechoic to fat (arrows) and the central portion is hyperechoic (arrowheads). This mass corresponds to the lesion identified in Figure 2–1.
Pathology
• hamartoma
Management
• BI-RADS Assessment Category 2, benign finding
Pearls and Pitfalls
1. Hamartoma is a benign tumor that consists of mature tissues normally present in the breast. However, usually one element dominates the mass. Mammographically, the mass is well defined but the density of the mass varies with its composition. If the mass does not have much fat, then it may be completely radiopaque. However, if the mass is a mixture of fat and other soft tissues, then it will be mixed density as in this case. If the mass is completely radiopaque, then the differential diagnosis is fibroadenoma, cyst, or carcinoma. If the mass has mixed density, then the mammogram is diagnostic of hamartoma.
2. Sonographically, hamartoma has a variety of appearances. The individual components of the tumor should sonographically match their corresponding normal elements within the breast. The fatty component is isoechoic to fat and the fibroglandular elements are hyperechoic to fat.
Suggested Readings
1. Adler DD, Jeffries DO, Helvie Mak. Sonographic features of breast hamartomas. J Ultrasound Med 1990;9:85–90.
2. Altermatt HJ, Gebbers J-O, Laissue J-A. Multiple hamaratomas presenting as discrete breast mass. Can Assoc Radiol J 1992;43:218–220.
3. Anderson I, Hildell J, Linell F, et al. Mammary hamartomas. Acta Radiol 1979;20:712–720.
4. Beatty SM, Orel SG, McCarthy DM, et al. Breast hamartomas: MR appearance. Breast Dis 1995;8:275–281.
5. Crothers JG, Bjkutler NF, Fortt RW, et al. Fibroadenolipoma of the breast. Br J Radiol 1985;58:191–202.
6. Evers K, Yeh I-T, Troupin RH, et al. Mammary hamartomas. The importance of radiologic-pathologic correlation. Breast Dis 1992;5:35–43.
Case 3
Case History
A 69-year-old woman with a right breast lump.
Physical Examination
• right breast: a 3 cm flat, mobile mass extends from the 1:00 to the 4:00 positions
• left breast: normal exam
Mammogram
Mass (Fig. 3–1)
• margin: circumscribed
• shape: oval
• density: fat-containing
Figure 3–1. In the right inner inferior breast there is a circumscribed mass containing fat (arrows). The mass is partially obscured by the surrounding breast parenchymal density. (A). Right MLO mammogram. (B). Right CC mammogram.
Ultrasound
Frequency
• 13 MHz
Mass
• margin: well defined
• echogenicity: heterogeneous
• retrotumoral acoustic appearance: no shadowing
• shape: ellipsoid (Fig. 3–2)
Figure 3–2. Right radial breast sonogram: The palpable lump corresponds to a well-defined mass of heterogeneous echogenicity. The appearance of this mass is confusing because within the mass are multiple focal fatty areas (isoechoic with fat), which are mistaken as individual masses and are measured separately. (Electronic caliper markers measure one fatty area.) The actual mass is a combination of the fatty masses and the more hyperechoic