Developing density left breast

Case contributed by Garth Kruger
Diagnosis almost certain

Presentation

Screening mammogram of 2009 and follow up studies 2010, and 2013 with ultrasound.

Patient Data

Age: 60
Gender: Female
mammography

No suspicious mass, architectural distortion or calcifications. 

mammography

2010 view with an addended image to illustrate the developing density. The CC view showed nothing but was marginally suboptimal.

Note how the mass just obscures the profile of the pectoral muscle on the MLO view? Train your eye to run down the profile of the muscle on the MLO view.

mammography

The study in 2013 is a diagnostic study. The IDC is now clinically palpable.

Region of palpable abnormality

ultrasound

The lesion has all the hallmarks of a malignant lesion on ultrasound.

Note how deep the lesion is lying on the pectoral fascia. This is why a good CC view needs to be "good" and not just a CC view.

Case Discussion

"Timelapse" mammography to illustrate the development of an asymmetrical density in the left breast.

The teaching point: on a CC view you need to see the pectoral muscle centrally just intrude on the image or you will miss lesions deep in the breast. Like in this case.

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