32 year old with history of left breast cancer. Extensive suspicious calcifications in the left breast. Mammographic asymmetry in the right inferior breast with questionable ultrasound correlate also seen. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, a limitation to the exam.In the left upper breast 12:00 anterior depth, near the biopsy site and associated with Hydromark biopsy clip artifact, is an area of mass like enhancement with associated foci/non-mass enhancement that is somewhat more enhancing than her extensive background. This measures 5.0 x 4.3 x 2.4 cm. A more faint area of non-mass enhancement that corresponds to the location of additional calcifications in the left outer breast measures 2.9 x 0.6 x 0.6 cm. In the right inferior breast there are three adjacent areas with low T2 signal and mild enhancement that likely correspond to the mammographic asymmetry. The largest two are located in mid to posterior depth and measure 1.5 x 0.9 x 1.2 cm and 0.9 x 0.7 x 0.5 cm. No abnormal lymph nodes are identified in either axillary region.
1. Extensive background enhancement limits the exam.2. Large abnormal area of enhancement in the left upper breast corresponding to the biopsy proven malignancy measures up to 5.0 cm.3. Additional equivocal area of enhancement laterally in the left breast. If mastectomy is not already planned on the left, then an additional stereotactic biopsy for the left outer breast calcifications should be performed.4. Right inferior breast enhancement corresponds to the mammographic asymmetry. Though more likely benign, suggest correlation with targeted ultrasound given the limitations of the supplied outside ultrasound images of the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.