Ms. Cooney is a 55 year old female with a personal history of basal cell carcinoma at age 40 years and a strong family history of breast and other cancers. Her mother had breast cancer at the age of 48 years. Her father had colon cancer at the age of 72 years, prostate cancer at 74 years and melanoma at 82 years. Her maternal aunt had breast cancer at 70 years. Her maternal grandmother had breast and ovarian cancer. Her maternal and paternal grandfathers had leukemia. The patient has a history of bilateral breast reduction in 2011. Mild parenchymal enhancement is noted bilaterally. Scattered fibroglandular tissue is present.RIGHT BREAST - Within the superolateral right breast, there is a tortuous ectatically dilated duct identified with increased T1 signal, consistent with proteinaceous fluid. At the terminal end of this duct, within the right nipple, is an irregular enhancing mass measuring 0.9 x 0.8 x 0.7 cm. These findings are highly suspicious for an intraductal mass with associated intraductal dilatation. LEFT BREAST - There is no abnormal enhancement identified within the left breast. No abnormal axillary lymph nodes are identified in either axillary region.
(1) Suspected intraductal mass with associated dilatation in the right superior breast. An MR-directed US is recommended for further evaluation of these findings. If a suspicious sonographic correlate is identified, an US-guided biopsy may be recommended at that time.(2) No MR evidence of malignancy in the left breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.