Ms. Chandler is a 49 year old female with a personal history of left breast mastectomy in 2010 for DCIS. Recent diagnostic workup in August 2016 revealed a cluster of calcifications in the right breast for which stereotactic biopsy has been recommended. Left reconstructed breast: The patient is status post left breast mastectomy with tissue based reconstruction. There is a focal area of enhancement seen superficially in the skin of the left superior breast, likely of benign etiology. There is no abnormal enhancement seen in the left reconstructed breast or chest wall.Right breast: There is heterogeneous amount of fibroglandular tissue in the right breast. In the right upper inner breast, there is a linear distribution of clumped nonmass enhancement identified measuring approximately 3.3 cm in AP dimension. This area corresponds to the mammographically detected linear distribution of calcifications, which will undergo stereotactic biopsy later today. Seen approximately 0.8 cm inferomedial to this is an additional focal area of enhancement, measuring up to 0.4 cm. This likely corresponds to an additional small cluster of calcifications seen medial to the index calcifications on the diagnostic mammogram.Total span of abnormal enhancement measures approximately 3.3 x 2.2 x 2.2 cm (AP x ML x SI).Axilla: Expected post surgical changes are identified in the left axilla. No abnormal lymph nodes are identified in either axillary or internal mammary region.
(1) 3.3 cm span of linear clumped nonmass enhancement in the right upper inner breast, corresponding to the mammographically detected calcifications. This area will undergo stereotactic biopsy later today. Of note, there is an additional focal area of enhancement seen 0.8 cm inferomedial to the index enhancement, corresponding to an additional small cluster of calcifications seen on diagnostic mammogram.(2) Focal area of enhancement seen superficially in the skin of the left superior breast, corresponding to a bug bite seen on the patient's skin upon visual inspection. No MRI evidence of malignancy of the left reconstructed breast.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.