Ms. Caddell is a 61-year-old female with recently diagnosed DCIS of the left breast. She presents today for MRI evaluation for staging purposes There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Left breast - In the left upper outer breast, there is a segmental distribution of clumped nonmass enhancement identified measuring approximately 4.6 x 2.6 cm in the AP x ML dimension, and 4.8 cm in the AP oblique dimension. This corresponds in location to the mammographically detected calcifications in the left upper outer breast, which are biopsy proven to be malignant. Susceptibility artifact from biopsy marker clip is seen centrally within this clumped nonmass enhancement.Seen approximately 2 cm inferior to this is an additional segmental distribution of clumped nonmass enhancement measuring approximately 2.0 cm in the AP dimension. Susceptibility artifact from biopsy marker clip with associated benign enhancing focus is seen in the left medial breast, at site of prior benign biopsy.Right breast - There is no abnormal enhancement seen in the right breast. Axillae - No abnormal lymph nodes are identified in either axillary or internal mammary region.Extra-mammary findings - Incidental note is made of a peripherally enhancing lesion in the manubrium, measuring approximately 3.5 x 2.4 cm. This lesion is associated with high internal T2 signal intensity and is partially visualized on prior MRI cardiac exam from 2012. Imaging findings favor a benign hemangioma.
(1) 4.8 cm clumped nonmass enhancement in a segmental distribution in the left upper outer breast, corresponding in distribution to the mammographically detected calcifications which are biopsy proven to be malignant.(2) 2.0 cm segmentally distributed clumped nonmass enhancement in the left inferior breast. An MR guided biopsy with clip placement is recommended for further evaluation.(3) No MRI evidence for malignancy in the right breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.