A patient submitted outside study for review. Submitted for review are breast MRI (3/28/2016) performed at Porter Regional Hospital. For comparison,breast imaging studies 3/29/2016 and priors dating back to 11/13/2008 are available. MRI 3/28/2016:Scout, axial T1, axial T1 postcontrast, axial T2 and axial T2 fat sat images were submitted for evaluation. Images were uploaded into PACS and reviewed with DynaCAD software.There is moderate heterogeneous fibroglandular tissue and mild background parenchymal enhancement in both breasts.Left Breast: In the upper outer quadrant near the 1:00 position, posterior depth, there is a heterogeneously enhancing mass with irregular margins, areas of necrosis and central clip artifact, consistent with the biopsy-proven malignancy. This mass measures 2.0 x 1.9 x 2.9 cm (AP x TV x CC) and demonstrates mixed kinetics. Immediately anterior to the mass, there is a clip artifact seen at the site of known prior benign biopsy. There is no abnormal enhancement surrounding this second biopsy clip, however a hematoma measuring 2.7 x 2.1 x 1.2 cm (AP x TV x CC) is seen near this biopsy clip. No abnormal enhancement identified elsewhere in the left breast. Right Breast: There a few nonspecific foci of enhancement which are likely related to background parenchymal enhancement. Specifically, no suspicious enhancement is seen in the lateral right breast at the area of mammographically identified indeterminate calcification or elsewhere in the right breast. Axilla: No abnormal lymph nodes are identified in either axillary region.
(1) Unifocal left breast 1:00 position, posterior depth biopsy-proven malignancy measuring 2.0 x 1.9 x 2.9 cm.(2) Small hematoma measuring up to 2.7 cm in the left breast 1:00 position, anterior depth, near the site of benign biopsy. Clip noted within the hematoma. No abnormal enhancement seen at that site. (3) No MR evidence of malignancy in the right breast. Stereotactic biopsy is still recommended for the indeterminate right lateral breast calcifications previously evaluated on diagnostic mammogram.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.