A patient submitted outside study for review. Submitted for review are digital mammographic images (8/17/15, 8/27/15), breast MRI (9/19/15) performed at Ingalls Memorial Hospital. For comparison, digital mammographic images (12/22/13, 10/4/12, 9/11/12) are available. DIGITAL MAMMOGRAPHIC IMAGES (8/17/15, 8/27/15):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There is a cluster of pleomorphic calcifications in the right breast at posterior upper outer quadrant.The cluster measures 20 x 8 mm (AP x LR).In the left breast, there is a stable oval mass (16 x 12 mm) at middle lower outer quadrant.No suspicious mass, microcalcifications or areas of architectural distortion are noted in left breast. BREAST MRI (9/19/15):Imaging protocol is outlined in the outside radiology report.Submitted images could not be processed by our workstation, therefore, this interpretation is made with axial images only.RIGHT BREAST:On the subtraction images, there is a linear non-mass enhancement measuring 23 x 11 mm (AP x LR) at posterior upper outer quadrant in the right breast, corresponding to the pleomorphic calcifications. A metallic artifact is present at the anterior aspect of this lesion, likely a marker clip. LEFT BREAST:In the left breast, there is a focal non mass enhancement, measuring 10 x 9 mm at upper outer quadrant.There is a lobulated cyst, measuring 14 x 8 mm at lower outer quadrant, corresponding to the stable mass seen on the mammogram. AXILLAE:No abnormal lymph nodes are identified in either axillary region.
1. Suspicious pleomorphic calcifications in the right breast at posterior upper outer quadrant. Per outside radiology report, this is a proven carcinoma.2. Focal non mass enhancement in the left breast upper outer quadrant. MR directed ultrasound is recommended. If no correlation is MR guided biopsy should be considered.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: U - Ultrasound Study Needed - No Letter.