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Training Collections
Library Memberships
Black Friday Save 30%On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Black Friday Save 30%Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Black Friday Save 40%Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
BLACK FRIDAY SAVE 30%Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Lesson
Sample Lesson
4 topics, 14 min.
Lesson
Palpable Lumps
5 topics, 16 min.
53-year-old woman with palpable lump in right breast
3 m.25-year-old woman with bilateral breast implants and palpable lump in right breast
2 m.78-year-old woman with palpable lump in right upper outer breast
5 m.54-year-old woman with palpable lump in left breast
5 m.38-year-old woman with palpable lump in right upper breast
5 m.Lesson
Breast Pain
3 topics, 7 min.
Lesson
Nipple Discharge
3 topics, 8 min.
Lesson
Skin Changes/Inflammation
10 topics, 23 min.
Skin Changes and Mastitis Overview
2 m.39-year-old woman with fever and cellulitis of the right breast, recently stopped breastfeeding
3 m.18-year-old woman with painful palpable lump in left breast
2 m.Granulomatous Mastitis Overview
2 m.29-year-old with palpable mass in left breast
2 m.31-year-old woman with palpable lump and skin redness in left breast
5 m.Inflammatory Breast Cancer Overview
2 m.55-year-old woman with skin thickening and redness in right breast
4 m.68-year-old woman with skin thickening and palpable lump in left breast
4 m.43-year-old woman with diffuse left breast pain and palpable lump. Family history of breast cancer
4 m.Lesson
Recall from Screening
29 topics, 1 hr. 7 min.
Asymmetry Overview
6 m.47-year-old woman recalled for asymmetry in left breast
4 m.59-year-old woman recalled for focal asymmetry in left breast
3 m.69-year-old woman recalled for developing asymmetry in right breast
4 m.46-year-old woman recalled for developing asymmetry in right breast
4 m.64-year-old woman recalled for calcifications and developing asymmetry
4 m.51-year-old woman recalled for developing asymmetry in right breast
3 m.79-year-old woman recalled for developing asymmetry in anterior right breast
4 m.Breast Mass Overview
2 m.43-year-old woman recalled for mass in left upper outer breast
3 m.40-year-old woman recalled for 12 mm mass in right breast
2 m.62-year-old woman recalled for mass in right upper outer breast
2 m.80-year-old woman with remote history of right mastectomy, recalled for mass in left breast
3 m.41-year-old woman recalled for mass in right breast
3 m.Architectural Distortion Overview
2 m.69-year-old woman recalled for architectural distortion in left breast
4 m.74-year-old woman recalled for architectural distortion in left breast
3 m.54-year-old woman recalled for distortion in left anterior breast
3 m.62-year-old woman recalled for distortion in left breast
3 m.Calcification Overview
1 m.54-year-old woman recalled for calcifications in left upper outer breast
2 m.57-year-old woman recalled for calcifications in left breast
2 m.51-year-old woman recalled for calcifications in right upper outer breast
2 m.60-year-old woman recalled for calcification in right breast
2 m.53-year-old woman recalled for calcifications in left breast
2 m.Large Axillary Lymph Node Overview
2 m.53-year-old woman recalled for large left axillary lymph node
3 m.80-year-old woman with history of breast cancer treatment recalled for large lymph nodes in left axilla
2 m.49-year-old woman recalled for asymmetry in left breast and large left axillary lymph node
3 m.Lesson
Surveillance After Breast Cancer Treatment
5 topics, 16 min.
Annual Surveillance after Breast Cancer Treatment Overview
4 m.57-year-old woman with history of right breast cancer 10 years ago. Annual follow up
3 m.62-year-old woman with history of left breast cancer 4 years ago. Annual follow up
4 m.61-year-old woman with history of left breast DCIS 10 years ago. Annual follow up
3 m.65-year-old woman with history of left breast cancer 12 years ago. Annual follow up
4 m.Lesson
Follow Up Probably Benign Findings - BI-RADS 3
5 topics, 16 min.
Follow Up Probably Benign Findings- BI-RADS 3 - Overview
8 m.60-year-old woman for 6 month follow up of probably benign calcifications in right breast
3 m.52-year-old woman for 12 month follow up of probably benign 5 mm oval mass in right breast
3 m.16-year-old girl for 6 month follow up of probably benign mass in right breast
3 m.56-year-old woman for follow up of probably benign clustered microcysts in right breast
4 m.Lesson
Follow up Benign Biopsy
3 topics, 5 min.
Lesson
Pregnant and Lactating Women
8 topics, 20 min.
Pregnant and Lactating Women Overview
6 m.26-year-old woman, 20 weeks pregnant, with left breast pain
2 m.32-year-old woman, 21 weeks pregnant, with palpable lump left breast
4 m.33-year-old lactating woman with palpable lump left breast
3 m.32-year-old woman, 1 year postpartum, breastfeeding, with palpable lump left breast
3 m.34-year-old woman, currently lactating, with palpable lump left breast
4 m.28-year-old woman, 1 year postpartum, with palpable lumps right breast
2 m.25-year-old woman, 1 month postpartum, breastfeeding, with palpable lump right breast
2 m.Lesson
Male Patients
5 topics, 12 min.
Symptomatic Male Patient Overview
4 m.65-year-old man with pain and palpable lump behind the left nipple for a few months
2 m.59-year-old man with enlarging and painful left breast over 6 months
3 m.77-year-old man with painful palpable lump in right subareolar breast
3 m.75-year-old man, BRCA2 carrier, with palpable lump in right breast
3 m.0:00
So our next patient is a 46-year-old
0:03
woman who was recalled for evaluation of a
0:05
developing asymmetry in the right breast.
0:09
So we have CC (craniocaudal) and MLO (mediolateral oblique) views from the screening
0:12
mammogram on this patient, and we can see
0:14
that there's a density here in the right
0:17
upper and outer breast, and compared to
0:21
some prior exams, this had really increased.
0:27
Over time so that now it was quite
0:31
apparent that there was a change here.
0:34
If I just pull up some of the prior images,
0:38
this is from a few years prior, you can see
0:41
that although there was a little bit of density
0:43
here, this really has developed over time.
0:47
So, you know, we have a developing asymmetry
0:50
that was recalled and we, uh, worked it up.
0:55
With some additional imaging, and that was
0:58
the CC and MLO spot compression views and a
1:01
full lateral view according to our protocol.
1:05
So this was the MLO spot compression
1:08
view and the CC spot compression view.
1:13
So you can see that that persists on both views.
1:18
And this was the true lateral view,
1:20
also showing this large area of asymmetric density.
1:25
And we had tomosynthesis images through this area.
1:32
You can see almost a nodular texture to
1:35
this tissue, but definitely persistent.
1:42
Tomosynthesis through the spot
1:44
compression in the MLO projection,
1:50
and there it is.
1:53
And tomosynthesis through the spot compression
1:58
in the CC or exaggerated CC projection.
2:02
So we have a definite finding there.
2:04
We thought this was large enough that we
2:06
might be able to see it on ultrasound.
2:08
So we went ahead and did an
2:09
ultrasound, and this is what we found.
2:12
So we found this echogenic area of tissue with
2:15
a lot of little hypoechoic spaces within it.
2:19
There it is in the radial projection and an
2:24
anti-radial pretty large patch of tissue.
2:27
A little bit of blood flow, not much,
2:32
but we felt like this was a definite correlate
2:35
to the mammographic finding, and that
2:37
we could target a biopsy to this area.
2:40
We gave this a BI-RADS 4, BI-RADS
2:43
Category 4 assessment, um, suspicious,
2:46
and we went ahead and recommended an
2:49
ultrasound-guided biopsy of this area.
2:52
So when we did the ultrasound biopsy, what we
2:54
got as a result was PASH again, pseudoangiomatous
2:58
stromal hyperplasia, and dense stromal fibrosis,
3:01
which we thought was benign and concordant.
3:03
So we've been following this since that time,
3:06
and there really has been no further change.
46-year-old woman recalled for developing asymmetry in right breast
HIDEInteractive Transcript
0:00
So our next patient is a 46-year-old
0:03
woman who was recalled for evaluation of a
0:05
developing asymmetry in the right breast.
0:09
So we have CC (craniocaudal) and MLO (mediolateral oblique) views from the screening
0:12
mammogram on this patient, and we can see
0:14
that there's a density here in the right
0:17
upper and outer breast, and compared to
0:21
some prior exams, this had really increased.
0:27
Over time so that now it was quite
0:31
apparent that there was a change here.
0:34
If I just pull up some of the prior images,
0:38
this is from a few years prior, you can see
0:41
that although there was a little bit of density
0:43
here, this really has developed over time.
0:47
So, you know, we have a developing asymmetry
0:50
that was recalled and we, uh, worked it up.
0:55
With some additional imaging, and that was
0:58
the CC and MLO spot compression views and a
1:01
full lateral view according to our protocol.
1:05
So this was the MLO spot compression
1:08
view and the CC spot compression view.
1:13
So you can see that that persists on both views.
1:18
And this was the true lateral view,
1:20
also showing this large area of asymmetric density.
1:25
And we had tomosynthesis images through this area.
1:32
You can see almost a nodular texture to
1:35
this tissue, but definitely persistent.
1:42
Tomosynthesis through the spot
1:44
compression in the MLO projection,
1:50
and there it is.
1:53
And tomosynthesis through the spot compression
1:58
in the CC or exaggerated CC projection.
2:02
So we have a definite finding there.
2:04
We thought this was large enough that we
2:06
might be able to see it on ultrasound.
2:08
So we went ahead and did an
2:09
ultrasound, and this is what we found.
2:12
So we found this echogenic area of tissue with
2:15
a lot of little hypoechoic spaces within it.
2:19
There it is in the radial projection and an
2:24
anti-radial pretty large patch of tissue.
2:27
A little bit of blood flow, not much,
2:32
but we felt like this was a definite correlate
2:35
to the mammographic finding, and that
2:37
we could target a biopsy to this area.
2:40
We gave this a BI-RADS 4, BI-RADS
2:43
Category 4 assessment, um, suspicious,
2:46
and we went ahead and recommended an
2:49
ultrasound-guided biopsy of this area.
2:52
So when we did the ultrasound biopsy, what we
2:54
got as a result was PASH again, pseudoangiomatous
2:58
stromal hyperplasia, and dense stromal fibrosis,
3:01
which we thought was benign and concordant.
3:03
So we've been following this since that time,
3:06
and there really has been no further change.
Report
Faculty
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
Tags
Women's Health
Ultrasound
Tomosynthesis
Neoplastic
Mammography
Breast
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