Nipple to lesion distance

Case contributed by Dr Garth Kruger

Presentation

Routine screening images of the right breast

Patient Data

Age: 60 years old
Gender: Female
Modality: Mammography

MLO and CC views of the right breast. 

Modality: Mammography

Its obvious the lesion on the MLO view is not he lesion marked on the CC view. The distance between the nipple and the lesion is discrepant on the two views. There must be something else going on here ....

Measure the distance between the nipple and the lesion with the 2nd finger and 5th finger of your right hand. Its must be the same on both images if it is the same lesion.

You recall the patient for rolled CC and MLO views (to get orthogonal images to extrapolate on ) and right breast ultrasound. At this stage its a Birads 0.

Modality: Mammography

On recall, ML and rolled CC views were performed. Look at the initial  images first and then on the annotated images.

Its clear there are 2 lesions in the right breast. On the initial imaging the one lesion was marked on the MLO view and the second lesion on the CC view. The clue is the discrepant nipple to lesion distance on the original images .

Modality: Ultrasound

The ultrasound images of the right breast are normal. The technologist and the radiologist both scan the patient.

Q: What do you do now?

A: its clear from the mammogram images there is something in the right breast. review with initial images of this patient (not shown) convincingly shows two small lesions in the right breast as shown above.

Repeat imaging ultrasound is done at a dedicated breast imaging centre. See below ....

Modality: Ultrasound

Two small lesions are found at 11 o' clock and 9 o' clock. The second image is badly cropped to exclude patient demographics.

Modality: Pathology

Report

Case Discussion

A rather laborious and long winded  demonstration of two specific points:

1. The distance between the nipple and a "lesion" should be the same on both views. Use your right hand, the second and fifth fingers and plot the distance running up and down on the initial and then second image. A "real" lesion should lie on this line. Its  a valuable aid to find a lesion on a second image. Try it, it works. And its free.

2. The more you do something, the better you get. Breast imaging is like golf. If you do lots of breast ultrasound you become proficient. And vice versa. If you work in a low volume ultrasound setting, do not hesitate to consult with a colleague and get a second opinion and if needs be (like in this case) another study.

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Case Information

rID: 22184
Case created: 17th Mar 2013
Last edited: 10th Dec 2016
System: Breast
Inclusion in quiz mode: Excluded

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