51-year-old with history of right breast excisional biopsy that showed mixed mammary carcinoma in situ. History of MR biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. There is globally increased enhancement within the right breast compared to the left. Scattered simple and complicated cysts are present.There is increased enhancement throughout the right breast, most notably near the site of prior MRI guided biopsy in the upper inner breast. Clip artifact is seen in the anterior aspect of an area of non-mass enhancement that now measures 3.7 x 1.4 x 2.9 cm, previously 3.1 x 1.6 x 1.9 cm. Additionally, scattered areas of focal and linear enhancement are present in the right breast, asymmetric when compared with the left. This includes two adjacent areas of linear enhancement in the upper inner breast measuring 1.3 and 1.7 cm, and another 1.2 cm area. Foci of left breast enhancement are not significantly changed, including a 5 mm focus in the left inner breast.No new abnormal axillary lymph nodes are identified in either axillary region. No change in previously noted right axillary lymph nodes. Subcentimeter high T2 signal hepatic lesions are most like cysts or hemangiomas.
Asymmetric enhancement of the right breast compared to the left, most notably in the upper inner breast. Routine diagnostic mammogram and right breast MRI directed ultrasound for this area is recommended. If no suspicious correlate is seen sonographically, MRI guided biopsy should be performed. Note that additional focal and non-mass enhancement is present on the right, and additional MRI biopsy could be considered depending on management plans for the breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.