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20° oblique projection

20° oblique projection is a troubleshooting projection used in mammography, especially in young women and in follow-up patients. Technique The C-arm is turned approximately 20° for a superomedial-inferolateral oblique. With the patient's feet pointing towards the unit and her torso turned slig...

Caudal cranial projection

Caudal cranial projection is an additional trouble shooting view. Technique invert the C arm as for a CC projection step the patient forward and have her bend excessively forward at the waist to ensure that the abdomen does not encroach in the x ray field place the image receptor abov...

Elevated craniocaudal projection

Elevated craniocaudal projection is an additional trouble shooting view. Technique direct beam superiorly to inferiroly face patient towards unit, feet forward lean patient inward, relaxing the shoulders bring inferior aspect of breast onto the image receptor pull breast outward...

Step-oblique mammography

Step-oblique mammography is an accurate technique for determining whether a mammographic finding visible on multiple images on only one projection (but not elucidated using standard additional mammographic projections) represents a summation artifact or a true mass and for precisely localizing t...

Triangulation

Triangulation is a technique for localizing lesions seen on at least two views on 2D mammography. Technique hang the CC, MLO, and 90° lateral films (in that order) on the view box the nipple on each film must be at the same level use a ruler and place one end over the lesion on the 90° later...

Lateral view

The lateral view is an additional view obtained at virtually every diagnostic evaluation. A lateral view may be obtained as a mediolateral view (ML) or lateromedial view (LM) view depending on where the imaging tube and detector are located. Technique for an ML view, the tube emitting the x...

Nevoid hyperkeratosis of the nipple and the areola

Nevoid hyperkeratosis of the nipple and the areola (NHNA) is a rare, idiopathic, and benign dermatological condition. Epidemiology Most often seen in females of reproductive age, especially during the 2nd and 3rd decades of life. Less than 70 cases have been reported till now. Clinical presen...

Conditions involving the nipple-areolar complex

The nipple areolar complex is a major anatomic landmark of the breast. It may be affected by variation in its embryological development, breast maturation and also by other benign and malignant conditions. Variant anatomy amazia polythelia nipple retraction or inversion enlarged nipple Ben...

Tuberous breasts

Tuberous breasts are congenital deformities of breast. They are defined by reduced parenchymal volume and herniation of breast tissue through the nipple-areola complex. Epidemiology The exact incidence is not clear. However, it is a common cause of patients presenting with breast asymmetry. Pr...

Subareolar abscess

Subareolar breast abscess are relatively uncommon and tend to occur mostly in young women. Clinical presentation Mastalgia, signs of inflammation, lump formation in the subareolar region and nipple discharge. In chronic cases fistula formation and nipple deformity may be seen. Some risk facto...

Step-and-shoot tomosynthesis (breast)

Step-and-shoot is a technology of image acquisition in digital breast tomosynthesis characterized by stop scanning at every single angle during images acquisition. Step-and-shoot technology allows advantages in microcalcifications conspicuity, spatial resolution, signal-to-noise Ratio improveme...

Flying focus tomosynthesis

Flying focus is a technology of image acquisition in digital breast tomosynthesis characterized by a continuous sweep during shooting. Sharpness in digital systems is determined by the modulation transfer function (MTF), which determine contrast transfer as a function of spatial frequency. Sin...

Suspensory ligament of the axilla

The suspensory ligament of the axilla is the inferior extension of the clavipectoral fascia on each side of the thorax. Gross anatomy The suspensory ligament of the axilla originates from the inferior border of pectoralis minor, where the 'leaflets' of the clavipectoral fascia have fused again...

Foramen of Langer

The foramen of Langer is a defect in the deep pectoralis fascia. It is a defect at the level of the third intercostal space, through which the upper lateral portion of the breast extends into the axilla forming the axillary tail of Spence.

Breast varix

Breast varix is, as the name suggests, varices in the breast that are focally dilated veins in the breast. Pathology If varices are seen bilaterally then a cause for central venous obstruction (superior vena cava syndrome) could be the underlying etiology with the varices being a part of the ...

Breast aneurysm

Breast aneurysms are a rarely seen cause of a breast mass. Pathology Types true aneurysm: occurs post trauma and is seen as a slowly enlarging pulsatile mass false aneurysm / pseudoaneurysm: occurs in acute trauma, post percutaneous biopsy, due to spontaneous hemorrhage secondary to coagulop...

Puerperal mastitis

Puerperal mastitis refers to mastitis occurring during pregnancy and lactation. Epidemiology It occurs most often during breast feeding and is rarely encountered during pregnancy. Pathology The source of infection is the nursing infants nose and throat; the organisms being Staphylococcus aur...

Gigantomastia

Gigantomastia (also known as macromastia or mammomegaly) is the term employed when there is massive breast enlargement. It is often associated with pregnancy. It may be rarely unilateral. Gigantomastia is a very common condition characterized by proliferation of either breast fatty tissue or gl...

Gestational and secretory hyperplasia

Gestational and secretory hyperplasia are pregnancy and lactation related physiological changes occurring in breast tissues. Pathology The normal physiology of pregnancy causes a lobular enlargement of terminal duct lobular units along with formation of new ones during the second month of gest...

Pseudocalcifications in the breast

Pseudocalcifications and artifacts in the breast include gold deposits in lymph nodes from intramuscular gold therapy for rheumatoid arthritis adhesive tape deodorant film-screen artifacts They should be differentiated from parenchymal calcification. Precautions to be taken are t...

Eggshell calcification (breast)

Eggshell calcifications in the breast are benign peripheral rim like calcifications Pathology They are typically secondary to fat necrosis or calcification of oil cysts. Radiographic features thin rim-like calcification (<1 mm in thickness) lucent centers small to several centimeter...

Breast calcifications (an approach)

An approach to breast calcifications in terms of imaging evaluation and biopsy aims to distinguish benign from malignant etiologies. This article overviews a general approach to the evaluation of breast calcifications. The types and descriptors of calcifications are detailed separately: breast c...

Large rod like breast calcification

Large rod like calcifications are benign calcifications seen within ectatic ducts. Pathology Associations plasma cell mastitis Radiographic features >1 mm in diameter may have lucent centers (if calcium is only in walls of ducts) branching pattern may be seen radiation towards the nipple...

Punctate microcalcification within the breast

Punctate microcalcifications within the breast are defined as calcific opacities <0.5 mm in diameter seen within the acini of a terminal ductal lobular unit. Epidemiology Associations fibrocystic changes skin calcification skin talc rarely in DCIS: punctate, clustered, segmentally distribu...

Popcorn calcification within the breast

Popcorn calcification in the breast is the classical description for the calcification seen in involuting fibroadenomas which, as the name suggests, has a popcorn-like appearance. Pathology A fibroadenoma in the long run may degenerate and calcify. Initially, there are a few punctate peripher...

PGMI evaluation system

PGMI (Perfect, Good, Moderate, Inadequate) is a method of evaluation of clinical image quality in mammography developed by the United Kingdom Mammography Trainers Group with the support of the Royal College of Radiographers, aimed to ensure the maintenance of a high standard of mammography in Br...

Aberrations in the normal development and involution of the breast

Aberrations in the Normal Development and Involution of the breast (ANDI) is an overarching term used to describe a wide spectrum of benign breast disease. As the name suggests, it is based on the theory that most of the encountered benign breast disorders are aberrations in the normal developme...

Montgomery glands

Montgomery glands are large sebaceous glands in the breast, representing a transition between a mammary gland and a sweat gland. Gross anatomy Located within the nipple-areolar complex, Montgomery glands open onto the skin surface via protrusions on the skin known as Montgomery tubercles. They...

Lymphatic drainage of the breast

Lymphatic drainage of breast originates from breast lobules and flows through intramammary nodes and channels into a subareolar plexus, called Sappey’s plexus. From this plexus, lymphatic drainage takes place through three main routes that parallel venous tributaries. Lymphatics from the left br...

Breast

The breast is an apocrine gland seen in both males and females. However, in females it has a specific function which is the production of milk for neonatal nutrition and immune function. Gross anatomy Composition The breast has an inhomogeneous structure which is predominantly composed of adi...

Amazia

Amazia is a rare congenital condition defined by the absence of breast tissue (glandular parenchyma in either one or both of the breasts) and a normal nipple and areola complex. However, the most common etiology of amazia is iatrogenic; biopsy of the developing breast and the use of radiation th...

Breast hypoplasia

Breast hypoplasia is a condition which is characterized by underdevelopment of the breast. Breast hypoplasia can be congenital or acquired. Pathology Congenital hypoplasia Associations include: ulnar-mammary syndrome Poland syndrome Turner syndrome congenital adrenal hyperplasia Acquired...

Amastia

Amastia is a rare congenital condition characterized by the absence of breast tissue, nipple and areola. This may occur unilaterally or bilaterally. Pathology During embryological development, breasts first appear as ectoderm ridges during the 6th week of gestation. This ridge grows thicker an...

Granulomatosis with polyangiitis (breast manifestations)

Breast involvement in granulomatosis with polyangiitis is seen in patients with avid systemic manifestations. Clinical presentation Clinically they can mimic carcinoma as a palpable, tender mass. Pathology Granulomatosis with polyangiitis (or formerly known as Wegeners granulomatosis) is a ...

Mammary duct ectasia

Mammary duct ectasia is the abnormal widening of one or more breast ducts to greater than 2 mm diameter, or 3 mm at the ampulla. It can be due to benign or malignant processes. Terminology Some publications use this term synonymously with periductal mastitis 7 or plasma cell mastitis 10,11, wh...

Breast amyloidosis

Amyloid deposition in the breast occurs predominantly in two forms breast involvement in primary amyloidosis - commoner in association with other conditions like multiple myeloma, plasmacytosis and rheumatoid arthritis and another in the localized form which is rarer. Clinical presentation ...

Supernumerary nipples

Supernumerary nipples, also known as accessory nipples or polythelia, are a common congenital malformation. The nipples may be either along the embryonic milk lines or beyond the milk lines, the latter type are called ectopic supernumerary nipples. Much more rarely, the nipples appear with compl...

Li-Fraumeni syndrome

Li-Fraumeni syndrome is a hereditary cancer syndrome due to mutations in the tumor suppressor gene TP53. Approximately half of affected individuals are thought to develop invasive cancer by 30 years of age 1. Associated malignancies sarcomas osteosarcoma rhabdomyosarcoma CNS tumors gliomas...

Metaplastic breast carcinoma

Metaplastic breast carcinoma, also known as spindle cell carcinoma of the breast, is a rare form of primary breast malignancy and accounts for <5% of breast carcinomas ref. These are scarce lesions, rarely seen in general radiology practice. The lesions usually present as a mass in postmenopaus...

Cavernous venous malformation

Cavernous venous malformation, also traditionally referred to as a cavernous hemangioma (despite it not being a tumor) or cavernomas, are non-neoplastic slow flow venous malformations found in many parts of the body. Terminology Despite the ubiquity of use of the traditional terms cavernoma, ...

Clustered microcysts

Clustered microcysts, or a microcystic cluster, refer to part of the spectrum of cystic change in the breast on ultrasound. They are part of aberrations in development and involution of the breast. Pathology These lesions have no malignant potential 1,2. Clinical presentation These lesions a...

Screening for breast cancer

Screening for breast cancer includes activities which test members of asymptomatic populations for breast cancer. Many advanced countries have breast screening programs. The most widely adopted method for breast cancer screening is mammography. There are few areas in imaging fraught with more c...

Breast imaging and the technologist

Breast screening and diagnostic programmes cannot exist without the technologists. They play an indispensable role in the acquisition of mammogram and ultrasound images in both screening and diagnostic settings. The mammogram technologist: the primary responsibility of the "mammo tech" is the ...

Nipple markers

Nipple markers can be a useful technique in the evaluation of small radiodensities overlying the expected position of the nipple on a chest radiograph. Not uncommonly a small round opacity projects over the lower thorax on a chest radiograph (see: solitary pulmonary nodule). Often, especially i...

Breast within a breast sign

The breast within a breast sign refers to the common mammographic appearance of breast hamartomas (fibroadenolipomas). Since these benign lesions are well-circumscribed and contain a mixture of fibrous, glandular and fatty tissue (just like normal breast), it is not surprising that they appear v...

Tucked CC views

In the standard CC views posterior tissue may be excluded from the field of view, due to the anatomical attachment to the chest wall restricting mobility of breast tissues. The tucks CC views are useful to depict lesions deep in the posterior portion of the breast, located between 10 and 2 o'clo...

Bullseye view

The bullseye view is designed for better evaluation of lesion located in retroareolar area. In this view, the nipple-areola complex are directed upward or downward on the detector surface to visualize the areolar and periareolar region en face, allowing characterization of lesions in this area.

Rolled CC view

Given that the rolled projections can be performed from any standard projection, the most commonly used is certainly the cranio-caudal one. A rolled CC view It's performed to locate a lesion only visible in the cranio-caudal view, or when overlapped tissues in the standard view can simulate or...

Medical devices in the thorax

Medical devices in the thorax are regularly observed by radiologists when reviewing radiographs and CT scans. Extrathoracic devices tubing, clamps, syringes, scissors, lying on or under the patient rubber sheets, foam mattresses, clothing, hair braids, nipple piercings, etc., may also be visi...

Spence tail

Spence tail is the prolongation of upper outer quadrant of the breast in the axillary direction. It is also called the axillary tail, once it passes through the foramen of Langer, it pierces the axillary fascia. The duct system is seen to extend into the axilla. If this direct continuity with t...

Chassaignac bursa

Chassaignac bursa (also known as the retromammary bursa, submammary serous bursa or occasionally Chassaignac bag) is the space behind the breast, lying between the pectoralis fascia posteriorly and deep layer of superficial fascia anteriorly. It contains loose connective tissue and aids in mobi...

XCCM view

An XCCM view is a supplementary mammographic view. It is a type of exaggerated cranio-caudal view. It is particularly good for imaging the medial portion of the breast. In this view, the medial portion of the breast is placed forward. A negative 15° tube tilt is suggested. An optimal XCCM view ...

Craniocaudal view

The craniocaudal view (CC view), along with the MLO view, is one of the two standard projections in a screening mammography. It must show the medial part as well as the external lateral portion of the breast as much as possible. A correctly performed CC projection may show the pectoral muscle o...

Magnification view (mammography)

A magnification view in mammography is performed to evaluate and count microcalcifications and its extension (as well the assessment of the borders and the tissue structures of a suspicious area or a mass) by using a magnification device which brings the breast away from the film plate and close...

Axillary view

An axillary view (also known as a "Cleopatra view“) is a type of supplementary mammographic view. It is an exaggerated craniocaudal view for better imaging of the lateral portion of the breast to the axillary tail. This projection is performed whenever we want to show a lesion seen only in the a...

Spot view (mammography)

A spot view (also known as a spot compression view or focal compression view) is an additional mammographic view performed by applying the compression to a smaller area of tissue using a small compression paddle, increasing the effective pressure on that spot. This results in better tissue separ...

Mediolateral view

The mediolateral (ML) view is a supplementary mammographic view and shows less breast tissue and pectoral muscle than the mediolateral oblique view (MLO view). Technique The tube is rotated 90 degrees and the lateral aspect of the chest wall is along the bucky edge. The height is at the level ...

Cleavage view

A cleavage view (also called "valley view") is a mammogram view that depicts the posteromedial portion of both breasts (the “valley” between the two breasts) by placing them on the cassette at the same time and pulling them anteriorly. Manual technical factors should be used. A cleavage view ...

Dilated ducts on breast imaging (differential)

Dilated ducts on breast imaging may be seen on many breast imaging modalities and can arise from a number of causes which can be both benign or malignant. physiological lactational changes mammary duct ectasia breast neoplasm 2-3

Well-defined breast cancers (differential)

Certain well-defined breast cancers tend to lack the characteristic spiculation and can give false reassurance of more benign entities on both ultrasound and mammography. These include: certain high grade invasive ductal carcinomas: not enough time for a desmoplastic reaction to form spiculatio...

Hyperechoic breast lesions

There are a number of lesions that appear hyperechoic on ultrasound. Such lesions can be either completely or partly hyperechoic and include both benign and malignant entities. Benign fat containing breast lesions lipoma of the breast fibroadenolipoma (hamartoma) of the breast fo...

Cystic breast mass

A cystic breast mass is a mass that contains both solid and fluid components. This can occur from both benign and malignant causes. Benign complex breast hematoma complex breast abscess breast cyst with associated inflammation and hemorrhage galactocoele fibrocystic changes and oil cysts 2...

Columnar cell lesions (breast)

Columnar cell lesions of the breast comprise a wide range of breast lesions which are commonly characterized by columnar cells lining the terminal ductal and lobular unit. These range from lesions that show little or no cytologic or architectural atypia to those that show sufficient cytologic an...

Milk fistula

A milk fistula is a situation where a fistulous connection develops between the skin and the lactiferous ducts. It is a rare but potential complication if a core biopsy or excision biopsy of the breast is performed in a lactating patient.

Intracystic papillary carcinoma (breast)

An intracystic papillary carcinoma of the breast is a type of papillary carcinoma of the breast. It accounts for a significant proportion of intracystic breast cancers. Epidemiology As with papillary carcinomas in general, it tends to occur in postmenopausal women. Pathology Pathologically, ...

Intracystic carcinoma (breast)

Intracystic carcinoma of the breast refers to a breast cancer located within a cyst. Epidemiology They represent ~0.2-1.3% of all breast cancers. Pathology Often they tend to represent papillary breast cancer 2: intracystic papillary breast carcinoma (ICPC) cystic degeneration of ductal c...

Sclerosing papilloma (breast)

Sclerosing papillomas of the breast are a subtype of intraductal papilloma of the breast. It is termed when a papillary lesion form well-defined solid masses with a dominant sclerosed architecture 2. It is usually a histological diagnosis and usually cannot be differentiated from a non-sclerosin...

Gel bleed in breast implants

Gel bleed is a phenomenon associated with silicone breast implants. Pathology Gel bleed refers to the microscopic diffusion of silicone gel through the breast implant elastomer shell. The implant shell, made of silicone, is a semipermeable membrane that allows for the egress or bleed of silico...

Calcific axillary lymphadenopathy (differential)

Calcific axillary lymphadenopathy is in general, more concerning than axillary lymphadenopathy alone and is particularly so if it contains microcalcifications. While this is concerning for malignancy, it can also occur from occasional nonmalignant causes. Pathology Etiology metastatic axillar...

Unilateral axillary lymphadenopathy (differential)

Unilateral axillary lymphadenopathy while being more concerning than bilateral axillary lymphadenopathy can still arise from a variety of benign, as well as malignant, causes. Benign mastitis other regional infective causes tuberculosis ipsilateral arm infection, e.g. cellulitis silicone i...

Skin thickening on mammography (differential)

The presence of skin thickening on mammography is variably defined, usually being more than 2 mm in thickness. It can result from a number of both benign and malignant causes. They include: Malignant inflammatory breast cancer: one of the most concerning causes of skin thickening: this usually...

Global asymmetry in breast tissue

Global asymmetry in breast tissue is a form of breast asymmetry where at least one quadrant of a breast has a larger amount of fibroglandular density than the corresponding area in the contralateral breast. There is no mass, suspicious calcification, or architectural distortion. This can occur ...

Asymmetry (mammography)

Asymmetries in mammography represent a spectrum of morphological descriptors for a unilateral fibroglandular-density finding seen on one or more mammographic projections that do not meet criteria for a mass. The term refers to a density finding and should not be confused with asymmetry in breast...

High risk breast lesion

The term high-risk breast lesion is given to a breast lesion that carries an increased risk for the future development of breast cancer or carries suspicion of a more sinister pathology around or in association with the lesion. The term has some overlap with borderline breast disease. Many radio...

Dilated mammary veins (differential)

Dilated mammary veins can result from many pathologies. These include: as a secondary but non specific sign of breast malignancy 1 ipsilateral subclavian venous obstruction SVC obstruction Mondor disease: can be dilated as well as being thrombosed

Ductal adenoma of the breast

A ductal adenoma of the breast is a benign glandular tumor of the breast that usually fills and distends the ductal lumen. Epidemiology They may occur in women of all ages, although the majority of patients are 60 years of age or greater 3. Clinical presentation Ductal adenomas usually prese...

Liponecrosis in breast

Liponecrosis in breast refers to areas of mammary fat necrosis with associated dystrophic calcification. It is further divided into: liponecrosis microcystica calcificans: <3 mm liponecrosis macrocystica calcificans: >3 mm Radiographic features Mammography Mammographic features are radioluc...

Dystrophic calcification within the breast

Dystrophic calcifications within the breast are usually seen as small macrocalcifications with relatively smooth margins. Pathology They are generally considered benign and can occur in a number of situations which include: evolving mammary fat necrosis post reduction mammoplasty 2 post tra...

Coarse macrocalcifications within the breast

Coarse macrocalcifications within the breast are a morphological descriptive term for a type of breast calcification. Epidemiology Associations involuting fibroadenomas (classic popcorn calcification) chronic renal disease with hypercalcemia 1 rarely seen in malignancy 2 invasive breast c...

Milk of calcium within a breast cyst

Milk of calcium within a breast cyst is a mammographic feature observed when there is dependent calcium layering within breast cysts. It is typically observed as "tea cup" or "crescent shaped" calcifications on a true lateral (LM or ML) view or occasionally on a MLO view. On a CC view, these cal...

Cystic hyperplasia of the breast

Cystic hyperplasia of the breast is a benign breast condition which is considered part of fibrocystic changes. Pathology There is usually greater unfolding and enlargement of ductules with formation of microcysts. Radiographic features Mammography If associated with secretion of calcium s...

Capsular contracture

Capsular contractures are a potential complication of a breast implant and refers to a tightening and hardening of the capsule that surrounds a breast implant. It is a condition that can distort the shape and cause pain in the augmented breast. It seems to be the commonest complication post-brea...

Amorphous calcifications (breast)

Amorphous calcifications, previously known as indistinct calcifications, are a morphological descriptor for breast calcifications that are small and/or hazy such that no clearly defined shape/form can be ascribed. Pathology Many benign and malignant conditions may be seen in association with ...

Suspicious breast calcifications

Suspicious breast calcifications are calcifications within the breast that have a morphology and/or distribution on mammography indicating a significant probability of malignancy. These merit further workup and biopsy 1. Radiographic features Technique Some calcifications may be more conspicu...

Transverse rectus abdominis musculocutaneous flap

Transplantation of a transverse rectus abdominis myocutaneous (TRAM) flap is a commonly used surgical procedure for breast reconstruction following mastectomy. An autologous myocutaneous flap consisting of abdominal skin, subcutaneous fat, the rectus abdominis muscle, and adjoining vasculature ...

Breast architectural distortion

Breast architectural distortion is a descriptive term in breast imaging (mammography, ultrasound, and MRI) to indicate that the breast parenchyma is tethered or indented. The finding per se is not a mass. Pathology Architectural distortion is often due to a desmoplastic reaction in which there...

Balloon breast brachytherapy

Balloon breast brachytherapy (BBB) is a technique for delivering radiation treatment in women with early-stage breast cancer. It is given after lumpectomy, or surgical removal of a small breast neoplasm, and is a shorter alternative to the more traditional method of external beam radiation for s...

Juvenile fibroadenoma (breast)

A juvenile fibroadenoma of the breast is a term given to a fibroadenoma presenting in children or adolescents. These may account for ~0.5-2% of all fibroadenomas, and are rapidly-growing masses that cause asymmetry of the breast, distortion of the overlying skin, and stretching of the nipple. 1...

Scirrhous carcinoma (breast)

Scirrhous carcinoma of the breast is a pathological subtype of breast cancer. It is a subtype of invasive ductal carcinoma not otherwise specified and presents as a hard lump. The proportion of pathologic lymph node metastasis among scirrhous carcinomas is significantly higher than that among ca...

Double spot compression view

A double spot compression view is obtained by focal compression of both sides of the breast to produce higher spatial and contrast resolution. This is made possible due to the increased amount of breast thinning and a significant decreased incidence of blurring because of decreased exposure time...

Mammotome

MammotomeTM is the brand name for the first vacuum-assisted breast biopsy system. See the article on stereotactic breast biopsy for general discussion of the procedure.

Mammary fat

The mammary glands develop in close association with a depot of adipose tissue that is commonly referred to as the mammary fat pad. The mammary fat pad is a matrix of adipose and connective tissue capable of mediating hormone action and synthesizing an array of growth regulatory molecules.

Breast sarcoma

Breast sarcoma refers to a relatively heterogenous group of rare breast tumors which can include: angiosarcoma of the breast pleomorphic sarcoma of the breast fibrosarcoma of the breast myxofibrosarcoma of the breast leiomyosarcoma of the breast primary osteosarcoma of the breast Epidemi...

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