Carcinoma right breast - increasing mammographic density

Case contributed by Garth Kruger


Palpable mass right breast

Patient Data

Age: 55 years
Gender: Female

For educational purposes, the layout for this case is slightly unconventional. The first two images are CC views of the right breast 2011 and 2012. Look at these two images thoughtfully first.

Note the subtle increased density of the focal parenchymal density lateral to and behind the right nipple?

Carcinoma is evident with skin thickening and nipple retraction.

Spiculated hypoechoic mass. 

Case Discussion

The teaching point is: malignant lesions do not have to grow to arouse suspicion. Increasing density in a lesion is also a red flag and deserves attention. Just because a lesion does not enlarge do not assume all is good. This case illustrates the point well.

Use a hanging protocol that allows you to compare density in the same image. Then once you are comfortable with this, change the protocol very couple of months so you "refresh/reboot" your observation skills. If you stay with one hanging protocol for years your eyes get lazy. Try it; it works.

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