67-year-old with previously diagnosed unifocal left breast invasive lobular carcinoma status post lumpectomy. Patient now presents for further evaluation. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. This limits the sensitivity of MRI in detecting subtle lesions.LEFT BREAST: There are postsurgical changes which include diffuse skin thickening and trabecular edema. A lobulated fluid collection is seen in the left lateral breast at the lumpectomy site measuring up to 7.4 cm in AP dimension, consistent with a seroma. Along the anterior and inferior aspect of the seroma, there is non mass enhancement measuring up to 4 cm. There is also a non mass enhancement along the anterior superior aspect of seroma measuring up to 1.8 cm. While findings are nonspecific, residual carcinoma cannot be excluded. Additional scattered subcentimeter foci of enhancement are seen throughout the right breast, nonspecific and likely secondary to background parenchymal enhancement.Postsurgical changes in the left axilla include a small seroma measuring up to 1.4 cm in the high axilla and edema in the subcutaneous tissues.RIGHT BREAST: There are two well-circumscribed masses with fatty hilum in the upper outer quadrant, consistent with benign intramammary lymph nodes. These are correlated to the most recent mammogram and appear similar. Additional scattered subcentimeter foci of enhancement are seen throughout the right breast, nonspecific and likely secondary to background parenchymal enhancement.No abnormal enhancement in the right axilla.
Postsurgical changes of the left breast with seromas in the lumpectomy bed and axilla. Nonspecific non mass enhancement along the anteroinferior and anterosuperior aspect of the seroma as described. Residual carcinoma cannot be excluded.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.