Calcifications

Question 1

What can a calcification be

Answer 1

Artifact, benign or suspicious

Question 2

Artifact

What materials can be artifacts/ mimic calcifications and how can you identify each of them

Answer 2

1. Deodorant: high density in axilla, doesn’t change position on different views inferring that it’s on the image receptor
2. Zinc oxide: collects on moles. It should disappear on follow up
3. Metallic artifact from electrocautery can leave small fragments; found next to scar tissue and is denser than calcium

Question 3

Which two calc distributions are most concerning for ca

Answer 3

Segmental > Linear (pic 473)

segmental> linear> grouped> regional> scattered

SLGRS

She loves going round sand (think beach trips)

Question 4

What types of benign calcifications are there

see 473

Answer 4

Dermal
Vascular
Popcorn
Secretory (Rod like) 
Egg shell
Dystrophic
Round

Think:
Popcorn looks round and dystrophic
Egg shells are dermal layers
Vascular/ Vessels secrete blood

Question 5

Features of dermal calcifications

Answer 5

Dermal:

1. Found in sweaty areas (axilla, cleavage, folds)
2. Often grouped together like a paw
3. They stay in the same place on CC and MLO views*** tattoo sign
4. When asked for confirmation: get a tangential view

Question 6

Features of vascular calcifications

Answer 6

Vascular:

Parallel, linear calcifications. Usually obvious

Question 7

Popcorn is a buzzword for

Answer 7

degenerating fibroadenoma;

they typically begin around the periphery and slowly coalesce over subsequent images

Question 8

Features of Secretory rod like calcifications and its buzzword

Answer 8

1. These are big, easily seen, point towards the nipple
2. Typically bilateral
3. Buzzword: cigar shaped with a lucent center or dashes but no dots
4. buzz age 10-20 years after menopause; THEY CANNOT HAPPEN IN PRE-MENOPAUSAL WOMEN. They only occur when the duct involutes. ( My thoughts - not in the book- young girls with premature ovarian failure basically have an early menopause)

Question 9

Features of egg shell calcifications and its buzzword

Answer 9

Fat necrosis that results from trauma (surgical or accidental)

Liponecrosis macrocystica: if massive - latin words are popular on exam

Buzz word: lucent centered ( recall secretory rod like are cigar shaped with lucent center)

Question 10

Features of dystrophic calcifications and its buzzword

Answer 10

Result from radiation, trauma or surgery. These are BIG.

Buzz word “irregular shape”

can also have lucent center ( recall secretory rod like are cigar shaped with lucent center and egg shell buzz word is lucent center)

Question 11

Differentiate btw secretory rod like, egg shell and dystrophic calcs.

Answer 11

see 474 or other flashcards.

Question 12

Features of round calcifications and its buzzword

Answer 12

• Scattered, BL, benign
• usually due to fibrocystic changes
• If clustered by themselves or are new they may need workup just like a mass
• if seen on the first mammo you can BR-3 them

Question 13

You see powdery spread out calcs on CC which layer on MLO and appear linear on ML with a curved bottom like a hemisphere. What is it and what is it due to and how can it be seen?

Answer 13

Milk of calcium; See 475 pics

Forms due to fluid filled in a lobule due to fibrocystic changes

Can only be seen with polarized light to assess birefringence

Question 14

What types of suspicious calcifications are there

Answer 14

1. Amorphous
2. Coarse heterogenous
3. Fine pleomorphic
4. Fine linear/ fine linear branching
5. Calc assoc with focal asymmetry/mass

Question 15

Amorphous

good table on 476 for ddx

Answer 15

looks like powdered sugar, cant be counted.

Distribution is key:

1. Segmental is suspicious
2. BL and scattered is benign

DDx:

1. Fibrocytic change (most likely)
2. DCIS (LOW GRADE)
3. sclerosing adenosis or columnar cell change

Question 16

Coarse heterogeneous

good table on 476 for ddx

Answer 16

1. Countable
2. with dull tips, they cant poke you (think of coarse salt)
3. larger than 0.5 mm
4. can be assoc with a mass (fibroadenoma or papilloma)

DDx:

1. DCIS (low intermediate grade)
2. Fibrocystic change
3. papilloma/ fibroadenoma

Question 17

Fine pleomorphic

good table on 476 for ddx

Answer 17

1. countable
2. sharp tips- would poke you
3. smaller than 0.5 mm
4. SECOND HIGHEST LIKELIHOOD of malignancy

DDx:

1. DCIS (high grade)
2. Fibrocystic change
3. Papilloma/ fibroadenoma (less likely)

Question 18

Fine linear / fine linear branching

Answer 18

1. this distribution makes fine pleomorphic calcifications more suspicious
   DDx basically is DCIS (mimics ductal proliferation)/ atypical look for secretory or vascular calcs.

HIGHEST likelihood of malignancy

Question 19

Which calcs have the highest and second highest rate of malignancy

Answer 19

Fine linear/ fine linear branching&raquo_space;> Fine pleomorphic

In answer choices pick fine linear branching over fine pleomorphic if both given as options, otherwise pick fine pleomorphic if fine branching is NOT an option.

Question 20

Whats a puff of smoke or warning sign

Answer 20

Seeing increased tissue density around suspicious calcifications as chance of cancer goes up.

US is useful for extent of disease

Question 21

If you see only pure calcifications should you get an US?

Answer 21

No unless if assoc with:

1. Palpable mass
2. visualized mass