Multiple variable-sized pulmonary opacities seen bilaterally scattered throughout both lung fields suggesting cannonball metastases.

Asymmetrical dense enlargement of the right breast.

Both lung fields are studded with multiple enhancing soft tissue masses, variable in size and configuration.

Bilateral enlarged axillary lymph nodes, larger and massive on the right side.

Right breast shows a large enhancing soft tissue mass in the upper outer quadrant measuring about 6 x 4 cm, a smaller enhancing focal lesion in the lower outer quadrant, a 4 x 3 cm cystic lesion in the upper inner quadrant, andskin thickening.

Multiple variable-sized hepatic focal lesions suggesting hepatic metastases.

Small bony lesions (right 6^th rib, left iliac bone suggesting bony metastases.

No available sagittal or coronal planes.

Right breast (suboptimal study):

• upper outer non-circumscribed hyperdense focal lesion with few microcalcifications

• architectural distortion

• skin thickening

• nipple retraction

Left breast: no suspicious mass or microcalcification

Opinion: highly suspicious right breast upper outer quadrant lesion, recommended for true cut biopsy (BIRADS 4C)

Ultrasound-guided true-cut biopsy from right breast mass lesion:

• under strict aseptic conditions with ultrasound guidance using lignocaine as local anesthetic, 4 cores were taken from the right breast upper outer quadrant mass lesion using 16 Gauge automatic biopsy needle

• the specimen was put in special containers and sent to the lab for histopathological analysis

• no immediate complications encountered

Conclusion: technically successful right breast mass biopsy as described

The pathology of the biopsied right breast mass revealed invasive ductal carcinoma, SBR grade II.