43-year-old with known left breast cancer with additional MRI findings for which ultrasound is requested. Patient also complains of a newly appreciable palpable area of concern in the left upper outer breast that she feels she has stopped breast-feeding. A targeted bilateral ultrasound was performed.For the patient's area of concern in the left outer breast near 2:00, adjacent simple and complicated cysts are present. This correlates with cysts seen on the MRI.For the MRI detected mass in the left lower outer quadrant, a 1.4 x 1.4 cm hypoechoic oval mass with internal vascularity is present and correlates with the MRI. This should be biopsied under ultrasound guidance.In the left inner breast near 9:00, a 9 x 7 mm hypoechoic region with apical vascularity is seen. This is indeterminant in appearance and should also be biopsied under ultrasound guidance.In the right lower inner quadrant no suspicious cystic or solid mass was apparent. Likely the MRI finding at this site was focal nodular parenchymal enhancement.In the right axillary region several adjacent lymph nodes with thickened cortices are seen. Cortical thickness is up to 5 mm and nonhilar blood flow is noted.
1. Left lower outer quadrant 1.4 cm hypoechoic mass correlates with MRI can be biopsied under ultrasound guidance.2. Left inner breast 9 mm hypoechoic region with apical vascularity is indeterminant in appearance, could be a correlate for the MRI finding and should also be biopsied under ultrasound guidance.3. No suspicious finding in the right lower inner quadrant, a reasonable result given the the low suspicion for the right breast finding from MRI.4. Indeterminate right axillary lymph node, at least as suspicious in morphology as the known metastatic lymph node in the left axilla. Ultrasound-guided biopsy is recommended.Orders for this biopsy to be performed tomorrow have been placed by Donna Christian and the patient is scheduled for 9:00 AM.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.