Talcum powder masquerading as punctate microcalcification on mammmography

Case contributed by Chris O'Donnell

Presentation

Palpbale mass in the left breast and incidental finding in the right breast

Patient Data

Age: 80 years
Gender: Female

Right mammogram and tomosynthesis

mammography

Extensive, punctate hyperdensity projected in the supero-lateral aspect of the breast.  No other diagnostic feature. 
MLO tomosynthesis: Most lateral "slice" of the tomosynthesis

CC tomosynthesis: Most cephalad "slice" of the tomosynthesis

 

Repeat mammogram 5 days later when presented for stereotatic biopsy of "calcification"

mammography

Punctate density has vanished - the patient's breast was thoroughly washed prior to performing this repeat examination.

Case Discussion

Talcum powder is a combination of talc (a radio-opaque mineral - hydrated magnesium silicate with the chemical formula H2Mg3(SiO3)4) and corn starch with perfumes.  It causes an appearance typical of punctate micro-calcification.  The key to diagnosis in the era of tomosynthesis is that the hyperdensity is not in the breast parenchyma (ie central slices) but on the skin edge ie the first or last slices of the tomosynthesis set.

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