BRANT: Chapter 20: #Pathologic (Imaging the Diagnostic Patient)

Question 1

This projection is used for magnification views over the MLO projection to evaluate for milk of calcium and for better localization

Answer 1

Lateral projection (ML or LM)

Question 2

T/F: When microcalcifications are being evaluated, typically magnification views in the CC and true lateral (either ML or LM) projections are performed.

Answer 2

True

Question 3

These views can be performed if there is suspicion for dermal calcifications

Answer 3

Tangential views

Question 4

Show lesions deep in posteromedial breast not seen in CC view

Answer 4

Cleavage view

Question 5

View for localizing lesion seen in one view

Answer 5

90-degree lateral

Question 6

View that determines lesion seen in one view by seeing how location changes

Answer 6

Rolled views

Question 7

View that improved visualization of superomedial tissue or used for improved tissue visualization and comfort for women with pectus excavatum, recent sternotomy or prominent pacemaker

Answer 7

Lateromedial oblique (LMO)

Question 8

Diagnosis

Answer 8

Skin calcifications

Question 9

Diagnosis

Answer 9

Milk of calcium in breast cysts

Question 10

Views the can evaluate asymmetries, mammographic findings that do not conform to a radiosense mass and that are only viewed in one project include the following when DBT is not available:
a. True lateral views
b. Rolled CC views
c. Both
d. Neither

Answer 10

c. Both

Question 11

Diagnosis

Answer 11

Fibroadenoma

Question 12

29/F with palpable breast mass. What is the recommended initial imaging modality of choice?

Answer 12

Ultrasound

Question 13

T/F: If the ultrasound identifies a suspicious finding in a young or pregnant patient, a mammogram should be performed to evaluate for extent of disease.

Answer 13

True

Question 14

Cyclic breast pain is defined by intermittent breast pain that spikes during the ____ phase and is thought to be primarily hormonal in etiology due to its relationship to the menstrual cycle

Answer 14

Luteal

Question 15

35/F with noncyclical pain. What is the recommended initial imaging modality of choice?
a. Mammography
b. Ultrasound
c. Either
d. No need for imaging evaluation

Answer 15

c. Either

If cyclical pain, no need for imaging evaluation

Question 16

Pathologic nipple discharge typically presents as the following:
a. Green in color
b. Nonspontaneous
c. Usually arises from multiple ducts
d. Serous

Answer 16

d. Serous

Pathologic nipple discharge presents as serous or bloody in color, spontaneous, unilateral, and arising from a single duct.

Physiologic nipple discharge can be green, yellow, or milky in color, nonspontaneous (only presents with expression), bilateral, and usually arises from multiple ducts.

Question 17

Most common etiology of pathologic nipple discharge

Answer 17

Intraductal papilloma

Question 18

42/F with pathologic nipple discharge. What is the recommended initial imaging modality of choice?
a. Mammography
b. Ultrasound
c. Either
d. Neither

Answer 18

a. Mammography

Question 19

42/F with pathologic nipple discharge have both negative mammographic and sonographic findings. What is the next best step for evaluation?
a. Galactography
b. MRI
c. Either
d. Both
e. NOTA

Answer 19

d. Both

Question 20

Mastitis is a common complication for breast feeding women, and typically caused by what organism?

Answer 20

Staphylococcus aureus

Question 21

Typically the modality of choice for initial evaluation for mastitis

Answer 21

Ultrasound

On ultrasound, mastitis is characterized by an area of heterogeneously altered echotexture from the edema within the parenchyma, skin thickening, and increased vascularity.

An abscess typically presents as a palpable mass with overlying erythema and appears sonographically as an irregular, indistinct, heterogeneously hypoechoic collection, sometimes with multiple loculations

Question 22

54/F presenting with breast erythema, tenderness and skin thickening resembling the outside of an orange. Given antibiotics with no complete resolution. Diagnosis?

Answer 22

Inflammatory breast cancer

Question 23

56/F presenting with itching, eczema, and ulceration of the nipple. What is the best imaging modality with best accuracy at finding an underlying malignancy?

Answer 23

Breast MRI

Diagnosis: Paget disease (characterized pathologically as invasion of the epidermis of the nipple by malignant cells)

Surgical biopsy for definitive diagnosis

Mammography: initial imaging method but is usually negative

Question 24

23/M. Diagnosis?

Answer 24

Normal male breast

Question 25

True regarding gynecomastia, except:
a. ACR recommends ultrasound as the initial imaging modality for any male greater than or equal to 25 years of age
b. Gynecomastia generally appears as a triangular or flame-shaped area of subareolar glandular tissue that points toward the nipple with fat interspersed within the parenchymal elements
c. The three patterns of gynecomastia include nodular, dendritic, and diffuse glandular.
d. AOTA are true

Answer 25

a. ACR recommends ultrasound as the initial imaging modality for any male greater than or equal to 25 years of age

Question 26

Most common breast cancer type in men

Answer 26

Invasive ductal carcinoma

Question 27

25/M. Diagnosis

Answer 27

Gynecomastia

Dendritic

Question 28

BI-RADS 3: probably benign assessment should be given to findings that have a less than ____ (%) chance to represent malignancy.

Answer 28

2%

Question 29

T/F: If priors are available and a finding is new, then it would not be appropriate to give a BI-RADS 3: probably benign assessment, despite the presence of probably benign imaging features. In this scenario, a BI-RADS 4: suspicious assessment should be used and biopsy recommended.

Answer 29

True

Question 30

Findings appropriate to be given BI-RADS 3 on initial imaging evaluation include:
a. Group of round calcifications
b. Oval, circumscribed mass
c. Focal asymmetry
d. All of the above

Answer 30

d. All of the above

Question 31

It is the most sensitive test for staging breast cancer

Answer 31

Breast MRI