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Abdomen > Breast > Flashcards

Breast Flashcards

0
Q

Indications

A

Used as an adjunct to mammography, a target rather than screening.

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1
Q

Second leading cause of cancer deaths in women next to lung cancer

A

Breast cancer.

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2
Q

Ultrasound vs Mammography

A

Mammo sees tiny micro Ca+

Mammo has hard time imaging dense breast

Ultrasound differentiates cystic vs solid

US characterizes a palp mass

US can assess with trauma,inflammation,augmentation

US guided cyst aspiration

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3
Q

Breast anatomy

A

Paired mammary glands containing fatty glandular and fibrous connective tissue

Parenchyma has 15-20 lobes, further divided into 20-40 lobules

Each lobe has a lactiferous duct 15-20 that converge at the nipple and enlg with lactation

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4
Q

Terminal duct lobular unit TDLU

A

< 2 mm, where most Breast pathology arises

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5
Q

Benign

A 
Lesion won't cross fibrous plane 
Well defined
Well circumscribed 
Smooth 
Mild lobulations 
Thin
Echogenic pseudocapsule
Round
Ovoid
Horizontal 
Wider than tall
Uniform
Hypoechoic 
Anechoic
Homogeneous
Non attenuating
Enhancement with cyst
Compressible
Mobile 
Fluid-filled lacks flow
Solid masses are hypovascular or lack a signal
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6
Q

Malignant

A 
Can invade fibrous plane 
Finger-like projections in radial
True shadow persists with pressure
Ill defined 
May indicate invasion
Spiculated
Angular 
Many small lobulations
Thick
Echogenic halo
Taller than wide
Irregular
Vertical 
Markedly hypoechoic
Heterogeneous
Attenuating
Shadowing
Non compressible 
Fixed
Increased peripheral flow (feeding vessel)
Increased internal flow (flow in tumor mosaic)
Clustered microcalcifications
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7
Q

Layers

A

Skin

Subcutaneous fat

Fascial plane

Mammary zone/ Breast parenchyma, glandular tissue

Retromammary fat

Muscle

Ribs

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8
Q

Blood supply

A

Arteries: internal mammary, lateral thoracic, thoracocromial, intercostal

Veins: superficial and deep networks. Axillary intercostal vein, vertebral veins

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9
Q

Glandular tissue is supported by

A

Cooper’s ligaments

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10
Q

Tail of Spence

A

Mammary tissue which may extend into axilla

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11
Q

Montgomery’s Gland

A

Sebaceous glands in areola

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12
Q

Skin thickness

A

2-3 mm

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13
Q

Fat is affected by

A

Age, parity, and obesity

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14
Q

Fatty tissue is ___ Echogenic than parenchyma

A

Less

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15
Q

Gynecomastia

A

Ductal elements enlarge in males.

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16
Q

Ducts

A

< or = 3 mm

Course towards nipple

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17
Q

Lymph nodes

A

Seen near axilla
< 10-15 mm
Kidney bean, echogenic hilum

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18
Q

Rotter’s nodes

A

Interpectoral group

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19
Q

Breast function

A

Fluid transport

Milk secretion via acini cells due to prolactin. Prolactin is suppressed by progesterone which is high during pregnancy and low after placenta is delivered. Baby sucking on nipple makes oxytocin which also raises prolactin.

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20
Q

Patient position

A

Supine/oblique with ipsilateral arm above head.

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21
Q

Fremitus

A

Power Doppler. Presence of flow confirms solid lesions.

22
Q

Hypoplasia

A

Underdeveloped breast

23
Q

Hypertrophy

A

Overdeveloped breast

May cause back pain and skin problems due to bra strap

24
Q

Polythelia

A

Accessory nipple
MC congenital anomaly
In milk line

(Embryos have breast buds that normally regress)
Black people
Can be confused with mole.
Assoc with renal cyst/duplication/unilateral agenesis

25
Q

Polymastia

A

Accessory breast
May occur with athelia (no nipple)
Enlg with puberty, pregnancy, and lactation. Can have breast pathology

26
Q

Cyst

A

MC breast lesion
Usually benign
35-50 yr old female
Pain, palp, mobile, compressible, no color flow within

Mammo: spherical or oval, low density, smooth margin, halo sign, eggshell with ca++

27
Q

Fibroadenoma

A

Common solid benign
15-40 yr old, black women
May get bigger when pregnant. Hormone influenced

Palp, mobile, nontender, may have macrolobulations

Well circumscribed, hypo, smooth margins

28
Q

Breast cancer

A

Affects 1 in 8 females
MC is invasive ductal carcinoma

Risk: female, fam hx, inc age

29
Q

Fibroadenoma

A

Common solid benign
15-40 yr old
May get bigger when pregnant. Hormone influenced

30
Q

Breast cancer

A

Affects 1 in 8 females
MC is invasive ductal carcinoma

Risk: female, fam hx, inc age, prolonged estrogen

Hard fixed painless mass, skin changes, nipple inversion

31
Q

Amastia

A

No Breast tissue and no nipple

32
Q

Amazia

A

No Breast tissue. Nipple is present.

33
Q

Unilateral early ripening

A

One breast develops before the other

34
Q

Precocious puberty

A

Breast develop before age 7

35
Q

Galactocele

A 
Milky cyst
Due to obstruction of lactiferous ducts
With pregnancy or lactation
May progress to mastitis or abscess
Usually subareolar
Resolves
36
Q

Sebaceous cyst

A

Mild to low level echoes. Oily cyst

37
Q

Intracystic papilloma

A

Soft tissue mass projecting into cyst

38
Q

Abscess

A

May result from mastitis
Affects lactating females
Often below nipple

Fever, pain, skin red and thick, palp, enlg nodes, purulent discharge, thick coopers lig, irregular, internal echoes, septations

Tx antibiotics, drainage

39
Q

Hematoma

A

Due to trauma

Variable echogenicity

40
Q

Ductal ectasia

A

Dilation of lactiferous ducts
Menopausal women
Prolonged nursing

Sticky thick discharge 
Subareolar nodularity
Nipple inversion
Intermittent pain
Dilated tubes coursing towards nipple 
Usually bilateral
41
Q

Cystosarcoma Phylloides

A 
Rare, 50 yrs
May be huge
Benign
May turn into Cancer. 
Similar to Fibroadenoma
42
Q

Intraductal papilloma

A

Growth in duct. Older women. Usually benign.

Asymptomatic, bloody nipple discharge. Palp subareolar mass. Ductal dilatation, soft tissue mass in duct.

43
Q

Lipoma

A

Encapsulated adipose tissue
Middle age and older women
> 2 cm usually
Compressible. Palp. May blend with breast.

44
Q

Invasive Ductal Carcinoma

A

MC 70-80%

Ill defined, hetero hypo, tall, attenuating, micro Ca+

45
Q

Infiltrating Lobular Carcinoma

A

8-15%

Lobulated borders, moderate attenuation.

46
Q

Medullary Carcinoma

A

Rare, younger females.

Round/lobulated, irreg margins, may hemorrhage

47
Q

Mucinous Carcinoma/Colloid Carcinoma

A

Rare, may be bilateral and multiple

Round/oval smooth wall hypo

48
Q

Papillary Carcinoma

A

Rare, older, palp

retroareolar mass, bloody discharge. Small mass, dilated duct

49
Q

Paget’s Disease

A

Eczema skin change of nipple
Assoc with underlying breast cancer 90%

Rash, bleeding, red areola, crust ulceration, itch, burn, discharge, nipple inversion.

50
Q

Mets from breast

A

Nodes, liver, lung, bone, brain

Lymphadenopathy rounded and loss of fatty hilum.

51
Q

Make breast cancer

A

Rare 1%

Risk: Kline Felters syndrome (extra X chromosome in males), transsexuals, orchitis tumors, liver disease

52
Q

Cyst more common in

A

Premenopausal females, females on estrogen or estrogen-progesterone hormone replacement therapy.

53
Q

Fat lobules

A

Hypo fat in area of dense tissue

Abdomen (15 decks)

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