35 year old with known right breast cancer, whose MRI (6/15/15) demonstrated additional enhancing lesions in both breasts and abnormal right axillary lymph node, for which MR directed ultrasound study is recommended. RIGHT BREAST: Index cancer is present at retroareolar region, slightly medial aspect, measuring 38 x 32 x 39 mm. There is a lobulated hypoechoic mass measuring 13 x 10 mm at 9:00 position, 1 cm from nipple. This mass might correspond to the additional enhancing lesion seen on the MRI. There are additional two small hypoechoic masses near this lobulated mass.RIGHT AXILLA: There is an enlarged lymph node, with cortical thickening of 11 mm at low axilla. In addition, there is smaller, but abnormal lymph node with cortical thickening, measuring 12 x 8 mm.LEFT BREAST: There are multiple intraductal masses at retroareolar region and lower inner quadrant, likely papillomata. These masses are likely corresponding to the multiple enhancing masses seen on MRI. In addition, there is a circumscribed oval hypoechoic mass at 7:00 position, 4 cm from nipple, likely benign fibroadenoma.
1. Right known cancer with possible satellite lesions posteriorly.2. Abnormal lymph nodes in right axilla.3. Probable multiple papillomata in the left breast, likely corresponding to MR findings. High probability benign mass, likely fibroadenoma, in the left breast at 7:00 position. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.