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Breast Ultrasound > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

What is fat necrosis of the breast?

A

Death of fatty tissue in the breast

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2
Q

What are the US appearances of fat necrosis?

A

Heterogenous, avascular, calcified rim (full or partial) within posterior acoustic shadowing, within subcutaneous layer, complex (solid and cystic)

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3
Q

What are the causes of fat necrosis?

A

Trauma, surgery, biopsy, patient on blood thinners, weight of large breasts.

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4
Q

What are four criteria associated with benign breast masses?

A

Hyperechogenicity, wider than tall, 3 or fewer lobulations, completely circumscribed within thin echogenic capsule

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5
Q

What are the US appearances of a breast abscess?

A

Uniform isoechoic thickened wall
Fluid-debris level
Hyperaemia of wall (vessels course parallel to wall)

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6
Q

What are the S+S of breast infection?

A

Tenderness
Erythema
Warmth in area
Fever
Leukocytosis
May have nipple discharge

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7
Q

What is mastitis and what is the main role of US during assessment?

A

Breast inflammation
Determine whether abscess is present
Age of abscess
Whether or not it is multilocular

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8
Q

What are the two types of breast mastitis?

A

Puerperal mastitis (mastitis associated with lactation)
Nonpuerperal mastitis (can occur in females and males)

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9
Q

What causes mastitis?

A

Pre-existing galactoceles
Inflamed cyst
Rupture of inflamed or affected duct (central abscess)

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10
Q

What are the US appearances of peripheral mastitis?

A

If formed from galactocele, thicker wall galactocele and often multilobulated or septated
Can be nonspecific - no fluid-filled underlying structures

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11
Q

What are the US appearances of central mastitis?

A

Arises from central ducts - walls of ducts are thick and isoechoic (rather than thin and echogenic)

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12
Q

What technical considerations apply to scanning patients with mastitis?

A

Use transducer with more penetration (breast becomes thicker with lactation and need to see to chest wall).

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13
Q

What are signs that are suspicious for malignancy (4x invasive, 3x DCIS, 3x both)?

A

Angular margins (greatest sensitivity)
Spiculation
Thick echogenic rim with antiparallel vascularity
Acoustic shadowing
Microlobulations
Calcifications
Duct changes
Hypoechogenicity
Taller than wide
Indistinct margins

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14
Q

What are indistinct margins (malignant breast lesion sign)?

A

Can’t distinguish margins, including when margins are the same echogenicity as surrounding tissue

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15
Q

What are spiculations or a thick, echogenic rim (malignant breast lesion sign)?

A

Spiculations - invasions into surrounding tissue that radiate from lesion
Thick echogenic rim - arises from spiculations which are too small to appreciate on US

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16
Q

What are microlobulations (malignant breast cancer sign)?

A

1-2mm lobulations that vary in number along the lesions surface.

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17
Q

What is duct extension a sign of?

A

Not specific sign of malignancy but suggests intraductal growth pattern.

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18
Q

What is acoustic shadowing in a breast lesion indicative of?

A

Invasive malignancy - occurs from the solid part of the lesion.

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19
Q

Do calcifications in a breast lesion indicate malignancy?

A

Malignant calcs lie within hypoechoic tumour substance (benign lie within a fairly hyperechoic background), so are able to be detected more easily.

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20
Q

What is architectural distortion (malignant breast cancer sign)?

A

Compression of surrounding tissues, obliteration of tissue planes, thickening or straightening of Coopers ligaments, changes in ductal patterns.

21
Q

What classifies skin thickening (malignant breast cancer sign)?

A

> 2mm (skin in periareolar area can be >4mm)

22
Q

What does oedema (malignant breast cancer sign) look like on US?

A

Appears as increased echogenicity of breast tissue and interdigitating hypoechoic lines (interstitial fluid or lymphatics).

23
Q

What is skin retraction (malignant breast cancer sign)?

A

Concave skin surface that appears ill-defined and pulled in.

24
Q

What is gynaecomastia?

A

Woman-like breasts seen in males.

25
Q

What causes gynaecomastia?

A

Imbalance between estrogenic and testosterone effects at the level of the breast tissue.

26
Q

What are the S+S of gynaecomastia?

A

Uni or bilateral subareolar thickening. or a lump.

27
Q

What are the US appearances of gynaecomastia?

A

Retroareolar, triangular hypoechoic mass. Spider-leg branching pattern (chronic).

28
Q

What is pseudogynaecomastia?

A

Breast enlargement from fat and not glandular tissue.

29
Q

What is ductal ectasia?

A

Subareolar and intermediate sized ducts become dilated and filled with thick secretions.
Duct walls and periductal tissues become inflamed.

30
Q

What are the S+S of ductal ectasia?

A

Nipple discharge
Nipple retraction
Can be asymptomatic in patients 60yo +

31
Q

What are the US appearances of ductal ectasia?

A

Distended tubular structures with anechoic contents >2mm diameter (best demonstrated using the two-handed compression manoeuvre).

32
Q

What is a galactocele?

A

Dilated cystic duct filled with milk

33
Q

What are the S+S of a galactocele?

A

Painless lump that appears a few weeks/months after cessation of breast feeding (can occur during breast feeding/third trimester)

34
Q

What are the US appearances of a galactocele?

A

Acute - anechoic from milk, simple uni or multiloculated, can have internal echoes
Older - hyperechoic or mixed solid/cystic

35
Q

Where are galactoceles most commonly located?

A

Periphery of breast or in accessory tissue (no ducts to lead draining)

36
Q

What are papillomas?

A

Wart-like tumours that grow in the ducts of the breast

37
Q

What are the S+S of papillomas?

A

Unilateral nipple discharge

38
Q

What are the US appearances of papilloma’s?

A

Isoechoic nodules that lie within ectatic fluid-filled ducts
CD present within

39
Q

What are abnormal appearances of a breast implant?

A

Capsule becomes too thick/causes capsular contracture
Tear through the capsule
Inflamed or infected
Associated mass that’s benign or malignant

40
Q

What may be the cause of a palpable lump in a patient with breast implants?

A

Radial folds when a patient is in a certain position
Fill valve of saline implants

41
Q

What is a intracapsular breast implant rupture?

A

Implant shell tears and contents spills into the space between the shell and the capsule (capsule = normal fibrous capsule formed by the body to wall off foreign object)

42
Q

What are the US features of an intracapsular rupture?

A

Stepladder sign (multiple linear hyperechoic lines stacked on top of one another)

43
Q

What is an extracapsular rupture?

A

Tear in the capsule and the shell

44
Q

What are the US features of an extracapsular rupture?

A

Silicone granuloma which creates a snowstorm appearance (hyperechoic and well-circumscribed anteriorly but dirty shadow posteriorly)
- Can spread over entire implant or just part of implant, or silicone can be picked up by LN’s and cause dirty shadowing
Acute - complex and cystic mass

45
Q

What are US features of malignant LN’s?

A

> 1cm (not specific)
Abnormally round or oval
Hypervascularity
Eccentric cortical thickening
Absence of hilum
Cortical thickness difference (c/w surrounding LN’s)

46
Q

What are S+S of breast malignancy?

A

Breast pain
Palpable abnormality
Nipple discharge which is unilateral and spontaneous

47
Q

What colour is nipple discharge from ductal ectasia?

A

Greenish and milky

48
Q

What pathology is bloody discharge associated with and why?

A

Periductal mastitis due to hyperaemia in duct wall and duct wall erosion

Breast Ultrasound (2 decks)

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