Ms. Bednarek is a 56-year-old female status post palpably-guided partial mastectomy for grade 2 ILC in the left breast with multiple positive margins (per EMR, positive margins were present at the medial, posterior, inferior, and lateral margins). There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left upper outer breast, a T2 hyperintense fluid collection is identified measuring 6.0 x 4.8 cm (AP x SI), compatible with the provided history of a recent lumpectomy. The seroma cavity is associated with irregular peripheral enhancement with at least six discrete areas of nodular thickening. These areas of nodular thickening are present in the following locations: anteromedial superior margin, anterolateral superior margin, inferior central margin and posterior central margin.The thickest area of nodular enhancement is present in the anteromedial superior margin, measuring up to 1.0 cm. These areas of nodular enhancement are highly suspicious for residual disease (particularly given the history of positive margins), however, fat necrosis cannot entirely be excluded. Several foci of enhancement are seen in the right breast, none of which appear more suspicious than the rest. No abnormal axillary lymph nodes are identified in either axillary region.
Postsurgical changes in the left upper outer breast with multiple discrete areas of focal nodular thickening around the seroma cavity, highly suspicious for residual disease. Recommend correlation with final pathology report along with surgical consultation for further management. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.