Ms. Sain is a 74 year old female presenting with bilateral indeterminate masses (which will be subsequently biopsied on same day as her MRI). She presents for an MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Numerous enhancing foci are seen in both breasts, compatible with moderate-marked background parenchymal enhancement, limiting the sensitivity of this examination.There is clumped non-mass enhancement identified throughout the entire superior left breast, spanning approximately 8.7 x 5.2 x 4.7 cm (AP x ML x SI). The enhancement extends up to the left nipple base. This corresponds in extent and distribution to the mammographically detected mass/calcifications in the left breast. In the right upper outer breast, there is a round enhancing mass identified measuring approximately 0.7 x 0.5 x 0.5 cm. This corresponds to the sonographically detected mass seen in the right breast 11:00 location. In addition, there are numerous enhancing foci seen scattered throughout the right breast. Some of these likely correspond to the sonographically detected simple cysts/complex cysts/ectatic ducts. No abnormal axillary lymph nodes are identified in either axillary region.
(1) 8.7 cm span of clumped non-mass enhancement in the left superior breast, corresponding to the mammographically detected mass/calcifications in the left breast. A two site biopsy will be performed later today for further evaluation.(2) 0.7 cm enhancing mass in the right upper outer breast, corresponding to the sonographically detected mass. An US-guided biopsy will be performed later today for further evaluation.(3) Numerous enhancing foci scattered throughout the right breast, some of which may represent the sonographically detected simple cysts/complex cysts/ectatic ducts. A short term 6 month MRI follow-up is recommended to ensure stability of these findings. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.