Summation shadow left breast

Case contributed by Dr Garth Kruger


Routine screening mammography

Patient Data

Age: 60 years old
Gender: Female

The cc view of the left breast shows a suspected spiculated density visible on the cc view only. It is not present on the MLO view or the previous study.


Management of a suspected summation shadow.

Repeat cc view left breast.

Case Discussion

Every now and again the senologist is confronted by a suspected "lesion" seen on one view only. The predicament is whether a full diagnostic workup is necessary or not........ this situation also leads to unnecessary recalls and the mental stress involved for the patient.

When you suspect a summation shadow, simply repeat the same view at the same visit, if possible. The second image is a repeat CC view. The difference in the beam/breast angle of the second image and the subtle difference in compression will often just "open" up the summation shadow. The "rolled" cc view at your institution does not have be be rolled much .... a couple of degrees is often enough. Exaggertion of the "roll" is not necessary.

For this reason where I work technologists who notice suspected lesions are encouraged to show the radiologist. We often use the above manouver to get an answer and avoid the trouble of recalls. Try it. It works. Plus your recall rate stays good.

Of course, if the lesion persists on the repeat image, workup is indicated. Don't be fooled into thinking that lesions seen on one image only are always innocuous. Thats is a fallacy.

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Case information

rID: 26782
Published: 8th Jan 2014
Last edited: 11th Mar 2016
System: Breast
Inclusion in quiz mode: Included

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