• margin: well defined
• echogenicity: hypoechoic
• retrotumoral acoustic appearance: no shadowing
• shape: ellipsoid (Fig. 6–2)
Figure 6–2. Left antiradial breast sonogram: A well-defined oval nodule corresponds to the palpable lump and the oval mammographic lucency. The nodule has a thin hyperechoic rim and a hypoechoic center.
Pathology
• oil cyst
Management
• BI-RADS Assessment Category 2, benign finding
Pearls and Pitfalls
The ultrasound nodule is consistent with either an organizing hematoma or an oil cyst. However, the mammographic fat density of the nodule is diagnostic of an oil cyst.
Suggested Readings
1. Tohno D, Cosgrove DO, Sloane JP. Benign processes—trauma and iatrogenic conditions. In: Tohno D, Cosgrove DO, Sloane JP, eds. Ultrasound Diagnosis of Breast Diseases. New York: Churchill Livingston; 1996:139–155.
Case 7
Case History
A 54-year-old woman is status post replacement of a left breast implant and now has a new mass on her screening mammogram.
Physical Examination
• normal exam
Mammogram
Mass (Fig. 7–1)
• margin: circumscribed.
• shape: oval
• density: fat-containing
Figure 7–1. Deep to the nipple in the posterior third of the left breast is a well-defined oval mass that contains a round lucent mass. (A). Left MLO mammogram. (B). Lefi CC mammogram.
Ultrasound
Frequency
• 7.5 MHz
Mass
• margin: well defined
• echogenicity: heterogeneous
• retrotumoral acoustic appearance: enhanced acoustic transmission
• shape: ellipsoid (Fig. 7–2)
Figure 7–2. Left transverse breast sonogram: The mass identified in Figure 7–1 corresponds to an anechoic fluid-filled cyst that contains a round heterogeneous mass, which represents the lucent mammographic mass. In real time this heterogeneous mass moves with changes in patient position and floats to the top of the fluid.
Pathology
• oil cyst
Management
• BI-RADS Assessment Category 2, benign finding
Pearls and Pitfalls
1. The mammographic mass corresponds to an oil cyst that is floating within a water density cyst. The oil cyst represents fat necrosis that resulted from removal of the previous implant.
2. Sonographically, oil cysts are generally round or oval, hypoechoic, isoechoic, heterogeneous, or less commonly hyperechoic compared with fat. When the oil cyst is not calcified, sound transmission is generally increased or unchanged. As in this case, the identity of the oil cyst is clarified by the mammogram.
Suggested Readings
1. Heywang-Kobrunner SH, Schreer I, Dershaw DD. Post-traumatic, post-surgical and post-therapeutic changes. In: Heywang-Kobrunner SH, Schreer I, Dershaw DD. Diagnostic Breast Imaging. New York: Thieme; 1997:280–316.
Case 8
Case History
A 68-year-old woman presents with a new mass on her left screening mammogram.
Physical Examination
• normal exam
Mammogram
Mass (Fig. 8–1)
• margin: circumscribed
• shape: oval
• density: equal density
Figure 8–1. At the 12:00 position of the left breast and the 3:00 position of the right breast there are two oval masses (arrows). The spot compression views demonstrate that the margins of the right mass are well defined and the margins of the left mass are ill defined. (A). Right MLO mammogram. (B). Left MLO mammogram. (C). Right CC mammogram. (D). Left CC mammogram. (E). Right CC spot compression mammogram. (F). Left CC spot compression mammogram.
Ultrasound
Frequency
• 10 MHz
Mass
• margin: ill defined
• echogenicity: hyperechoic
• retrotumoral acoustic appearance: no shadowing
• shape: ellipsoid (Figs. 8–2 and 8–3)
Figure 8–2. Right radial breast sonogram: The right mammographic mass identified in Figure 8–1 corresponds to an oval well-defined hyperechoic mass.
Figure 8–3. Left radial breast sonogram: The left mammographic mass identified in Figure 8–1 corresponds to a hyperechoic mass similar to the right breast mass.
Pathology
• angiolipoma
Management
• BI-RADS Assessment Category 4, suspicious; biopsy should be considered
Pearls and Pitfalls
1. Uniformly hyperechoic sonographic masses are generally benign, but the Category 4 (suspicious) assessment is based upon the information that the masses are new and the left mass is mildly ill defined mammographically.
2. Clinically, angiolipomas resemble lipomas. Over 75 % of patients are older than 50 years. Angiolipomas in other sites of the body generally are associated with pain. However, breast angiolipomas are generally painless. Microscopically, the mass consists of mature lipocytes associated with an extensive vascular network. Microthrombi are a prominent feature of the lesion. This mass is benign and does not recur.
Suggested Readings
1. Brown RW, Bhathal PS, Scott PR. Multiple bilateral angiolipomas of the breast. Aust NZ J Surg 1982;52:614–616.
2. Fleishman JS, Schwartz RA. Angiolipoma presenting as a breast mass. Ariz Med 1980;37:403–404.
3. Sibala JL, Chang CH, Lin F, et al. Computer tomography of angiolipoma of the breast. AJR 1980;134:840–841.
Case 9
Case History
A