EURORAD ESR

Case 360

The red herring – Developing density

Author(s)
Ilie I.Craciun MD
 
Patient
female, 59 year(s)
 
 
  • Published 08.05.2000
  • DOI 10.1594/EURORAD/CASE.360
  • Section Breast Imaging
  • Case Type Clinical Cases
  • Difficulty Resident
  • Views 32056
  • Language(s)
  • Figure 1
    – Mammographic examination 1988
     

    – Cranio-caudal projections – Mostly fatty breasts with some fibroglandular tissue behind the areola. There are no dominant masses, no microcalcifications or architectural distortion. The skin is normal. A small...

     
    Area of Interest: unknown; Imaging Technique: – Mammographic examination 1988;

    Lateral projections – True lateral projections of the breasts, standard position at the time, shows the same breast composition, with the fibroglandular tissue distributed mostly behind the areola. Again, no...

     
    Area of Interest: unknown; Imaging Technique: – Mammographic examination 1988;
     
     
  • Figure 2
    Digital magnification of the left breast mass - 1988

    Digital enlargement of the mass, in both projections, corresponding to a closer look, through a magnifying lens, shows that the finding is pretty well defined, with somewhat knobby and partially blurred margins. At...

     
    Area of Interest: unknown; Imaging Technique: Digital magnification of the left breast mass - 1988;
     
     
  • Figure 3
    Mammographic examination 1989
     

    Cranio-caudal projections – One year later, no definite changes may be noted. Even the small mass within the left breast does not show any notable changes and probably looks smaller and less dense.

     
    Area of Interest: unknown; Imaging Technique: Mammographic examination 1989;

    Lateral projections – Again, lateral projections of both breasts, showing no changes from the previous mammogram. The small mass is only hardly visible. The asymmetry of the breast tissue was attributed to the...

     
    Area of Interest: unknown; Imaging Technique: Mammographic examination 1989;
     
     
  • Figure 4
    Digital magnification of the left breast mass - 1989

    The upper outer quadrant mass has almost disappeared. It looks smaller, less dense compared with previous mammogram and its borders are well defined. In the lateral projection it can be hardly identified. The...

     
    Area of Interest: unknown; Imaging Technique: Digital magnification of the left breast mass - 1989;
     
     
  • Figure 5
    Mammographic examination 1991
     

    Cranio-caudal projections – Few changes may be noted, compared with the last mammogram, performed two years ago. The mass we were concerned about, hasn't changed in size, nor its borders had changed, but now a...

     
    Area of Interest: unknown; Imaging Technique: Mammographic examination 1991;

    ML Oblique projections – Even in this projection, the small left breast mass shows no changes, except for the coarse calcification within it. The right breast shows the asymmetric neodensity behind the nipple and...

     
    Area of Interest: unknown; Imaging Technique: Mammographic examination 1991;
     
     
  • Figure 6
    Bilateral suspicious findings
     

    Digital enlargement of the left breast mass shows it without any change from the previous mammograms, except for the coarse calcification within it. It was interpreted as a small fibroadenoma and no further attention...

     
    Area of Interest: unknown; Imaging Technique: Bilateral suspicious findings;

    Detail of the suspicious findings on the right breast shows granular calcifications dispersed within the inner lower quadrant and retroareolar area of the right breast. Some of them are arranged in a ductal pattern....

     
    Area of Interest: unknown; Imaging Technique: Bilateral suspicious findings;
     
     
  • Figure 7
    Digital enlargement - Rt. retroareolar region

    Dense fibroglandular tissue in the retroareolar area. No masses with definite borders or a center with increased density may be noted in the area. A region of denser breast tissue mixed with fat, accompanied by some...

     
    Area of Interest: unknown; Imaging Technique: Digital enlargement - Rt. retroareolar region;
     
     
  • Figure 8
    Evolving view
     

    An evolving picture of the cranio-caudal projections, shows the density in the inner half of the breast, growing from normal fibroglandular breast tissue to a breast density. The difference is obvious when seen in...

     
    Area of Interest: unknown; Imaging Technique: Evolving view;

    Comparative view of the lateral-oblique projections. Although different projections, in accordance to the development of the mammographic technique, there is an obvious increase in the density of the breast tissue in...

     
    Area of Interest: unknown; Imaging Technique: Evolving view;
     
     
– Cranio-caudal projections – Mostly fatty breasts with some fibroglandular tissue behind the areola. There are no dominant masses, no microcalcifications or architectural distortion. The skin is normal. A small oval mass, growing with the long axis toward the nipple is noted within the lateral part of the left breast. The mass is homogenous, mostly well defined and its longest axis measures 10 mm.
 
Lateral projections – True lateral projections of the breasts, standard position at the time, shows the same breast composition, with the fibroglandular tissue distributed mostly behind the areola. Again, no suspicious finding is noted, except for the small mass in the upper part of the left breast, disposed along the fibrotic breast lines. A small amount of asymmetric breast tissue is probably present within the lower part of the left breast, but it doesn't show any suspicious characteristic.
 
Digital enlargement of the mass, in both projections, corresponding to a closer look, through a magnifying lens, shows that the finding is pretty well defined, with somewhat knobby and partially blurred margins. At the time, the examiner felt that a small mass of low density and arranged along the fibrotic structures of the breast, does not represent a real threat and recommended annual follow-up.
 
Cranio-caudal projections – One year later, no definite changes may be noted. Even the small mass within the left breast does not show any notable changes and probably looks smaller and less dense.
 
Lateral projections – Again, lateral projections of both breasts, showing no changes from the previous mammogram. The small mass is only hardly visible. The asymmetry of the breast tissue was attributed to the underexposure of the left breast
 
The upper outer quadrant mass has almost disappeared. It looks smaller, less dense compared with previous mammogram and its borders are well defined. In the lateral projection it can be hardly identified. The mammogram was interpreted as normal and again, annual follow-up, was recommended.
 
Cranio-caudal projections – Few changes may be noted, compared with the last mammogram, performed two years ago. The mass we were concerned about, hasn't changed in size, nor its borders had changed, but now a somewhat coarse calcification may be seen within it. The right breast though, has changed a lot. Some granular microcalcifications, arranged in a ductal pattern, may be seen in the inner part of the breast and more than that, a region of dense breast tissue, asymmetric, may be seen just medial to the nipple.
 
ML Oblique projections – Even in this projection, the small left breast mass shows no changes, except for the coarse calcification within it. The right breast shows the asymmetric neodensity behind the nipple and the granular calcifications disposed in a ductal pattern, in the lower part of the breast. Some small calcifications are seen isolated, deep in the center of the breast.
 
Digital enlargement of the left breast mass shows it without any change from the previous mammograms, except for the coarse calcification within it. It was interpreted as a small fibroadenoma and no further attention was accorded to it.
 
Detail of the suspicious findings on the right breast shows granular calcifications dispersed within the inner lower quadrant and retroareolar area of the right breast. Some of them are arranged in a ductal pattern. The significance of this finding is not clear. On the other hand, the retroareolar breast tissue, looks denser and probably distorted. No definite mass is noted and the lesion can not be precisely identified in the other view.
 
Dense fibroglandular tissue in the retroareolar area. No masses with definite borders or a center with increased density may be noted in the area. A region of denser breast tissue mixed with fat, accompanied by some architectural distortion and probably spiculations may be suspected. No microcalcifications are attached to the finding.
 
An evolving picture of the cranio-caudal projections, shows the density in the inner half of the breast, growing from normal fibroglandular breast tissue to a breast density. The difference is obvious when seen in evolution and it is identifiable in the last mammogram compared to the previous one, taken two years before. Prospectively, it is not possible to assign a pathologic meaning to the change between the first two mammograms.
 
Comparative view of the lateral-oblique projections. Although different projections, in accordance to the development of the mammographic technique, there is an obvious increase in the density of the breast tissue in the retroareolar area. It can be said that on the '89 picture some increase in density and an impression of spiculations can be retrospectively noted, but at the time and correlated with the CC views, this very discrete changes were not appreciated. The last picture, from '91 shows with clarity the neodensity, mixed with fat, which evolved slowly over three years
 
 
 
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