Ms. Mauldin is a 50 year old female presenting with segmentally distributed calcifications, enlarged left intramammary lymph node and enlarged left axillary lymph nodes. She presents for MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST:Spanning the entire left lateral breast, there is extensive, segmentally distributed, non-mass enhancement seen measuring approximately 13.9 x 4.9 x 7.7 cm (AP x ML x SI). The enhancement extends from the left nipple base to the pectoralis muscle posteriorly. Although this enhancement abuts against the pectoralis muscle, the muscle itself is of normal contour and enhancement pattern.Within this nonmass enhancement, there are three discrete irregular enhancing masses identified, the largest of which measures approximately 2.6 x 1.8 x 2.5 cm. These are suspicious for invasive components.In addition, there is an enlarged intramammary lymph node identified, measuring up to 1.3 cm.RIGHT BREAST:There is no abnormal enhancement seen in the right breast.AXILLAE:Unfortunately, there is a shimming artifact seen in bilateral axillary regions, limiting evaluation of this area. However, based on recent ultrasound workup, several borderline enlarged left axillary lymph nodes were seen.
(1) 14 cm of extensive nonmass enhancement in the left lateral breast, extending from the pectoralis muscle to the nipple base. This corresponds in distribution and span to the mammographically detected calcifications. A two site ultrasound guided biopsy with clip placement will be performed later today.(2) Enlarged left intramammary lymph node and sonographically detected enlarged left axillary lymph nodes. An ultrasound-guided biopsy with clip placement will be performed of the intramammary lymph node and one left axillary lymph node later today.(3) No MR evidence of malignancy in the right breast.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.