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Case 16

Case History

A 53-year-old woman presents with a new area of bruising in the right upper breast. She does not remember any trauma. She feels a lump under the bruise.

Physical Examination

• right breast: ecchymosis associated with a palpable nodule in the upper breast at approximately 12:00

• left breast: normal exam

Mammogram

Mass (Fig. 16–1)

• margin: circumscribed

• shape: lobular

• density: equal density

Figure 16–1. At the 12:00 position of the right breast, there is a lobulated density. (A). Right MLO mammogram. (B). Right CC mammogram. (C). Right CC spot compression mammogram.

Ultrasound

Frequency

• 7 MHz

Mass

• margin: well defined

• echogenicity: heterogeneous

• retrotumoral acoustic appearance: bilateral edge shadowing

• shape: ellipsoid (Figs. 16–2 and 16–3)

Figure 16–2. Right radial breast sonogram: The mammographic density identified in Figure 16–1 corresponds to an oval mass of heterogeneous echogenicity with a hyperechoic rim.

Figure 16–3. Right radial breast sonogram: One month after the sonogram performed in Figure 16–2, the sonographic mass is smaller and has changed in appearance to an oval predominantly hyperechoic mass. This change in size and appearance is consistent with a healing hematoma.

Pathology

• hematoma

Management

• BI-RADS Assessment Category 3, probably benign; short-interval follow-up

Pearls and Pitfalls