History of right breast IDC on recent biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Proven malignancy with biopsy clip is seen as an enhancing mass measuring 1.5 x 1.6 x 1.7 cm in the right outer breast near 9:00. Immediately lateral/anterior to the index mass is a 6 mm satellite. There are multiple additional masses medial to the index lesion in the far posterior breast as well as a 9 mm extent of anterior non-mass enhancement extending anterior to the additional masses. Three of these are adjacent masses, all measuring about 6 mm each, that are present near the pectoralis muscle in the central posterior depth. An additional 1.1 x 1.8 cm enhancing mass even further medial localizes to the anterior aspect of the pectoralis muscle itself. Inclusive of these findings, overall extent measures up to 6.2 x 3.5 cm. Within the right chest wall, there are two areas of enhancement that appear to lie within chest wall soft tissues probably in intercostal muscles. Though non-specific in appearance, their proximity to the primary tumor and the satellite lesions raises concern for additional tumor involvement. No abnormal enhancement is seen in the left breast. A few scattered foci and areas of edge parenchymal enhancement are not suspicious. No abnormal axillary lymph nodes are identified in either axillary region.Within a mid-upper thoracic vertebral body, there is a high T2 round area without clear enhancement. Statistically, this is probably a hemangioma, though other etiologies are possible.
1. Biopsy proven right breast cancer with multiple additional masses and non-mass enhancement in the breast. The overall extent of masses, inclusive of the mass suspicious for pectoralis involvement is up to 6.2 cm.2. Areas of enhancement in the pectoralis muscle and right chest wall are all suspicious for tumor involvement of muscles. 3. Non-specific high T2 signal lesion in the thoracic spine may be a hemangioma. Findings were discussed with Dr. Jaskowiak. Additional imaging work up will likely include bone scan and CT. PET may also be considered. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.