Breast Assignment

Use the document entitled Advanced Breast Sonography available on the SDMS website 2011
Annual Conference Proceedings to help answer the following questions:

1. Label and identify the sonographic features of the following:

2
3
4

1
f
h
f
h
h
:
c
o

6
7
8

1)
2)
3)
4)
5)
6)
7)
8)

Coopers ligament: echogenic, linear structures

Skin: echogenic
Subcutaneous fat: med to low level gray
Pre-mammary fascia: echogenic
Mammary zone: hypoechoic when compared to the skin
Retro-mammary fascia: echogenic
Retro-mammary zone: hypoechoic when compared to the skin
Pectoralis: distinctly hypoechoic in comparison with adjacent structures

2. Explain the relationship among breast ducts, lactiferous ducts, lobes and lobules.
Many lobules make up a mammary lobe, from which secondary tubules form mammary ducts,
which lead to lactiferous ducts that exit at the nipple.
3. Explain at 3 scan techniques that can be used to evaluate the nipple.

1) peripheral compression technique: creates a 90 degree angle between U/S beam and the
peripheral sub areolar duct segment.
2) two-handed compression technique: creates a 90 degree angle between U/S beam and the
central sub areolar duct segment
3) rolled nipple technique: creates a 90 degree angle between U/S beam and the duct segment
within the nipple to the orifice
4. Why would a patient present with nipple discharge?
A patient might preset with nipple discharge if they had large duct papillomas, carcinoma, duct
ectasia, benign fibrocystic change with communicating cysts, and hyperprolactinemia.
5. Why would it be important to identify an intraductal papillary mass?
It is important to identify and examine any intraductal mass seen so that the mass can be
examined to make sure it is not a cancerous mass that could metastasize and cause further
problems.
For questions 6-10, find images that correlate with the following pathologies. Copy and paste
the images into this document - provide the url with the image.
6. Intraductal papilloma

http://www.ultrasoundcases.info/Slide-View.aspx?cat=301&case=1136
7. Implant with a radial fold

http://www.ultrasoundpaedia.com/normal-breast/
8. Sebaceous cyst

http://radiopaedia.org/cases/sebaceous-cyst
9. Ruptured implant

http://www.ultrasoundcases.info/Slide-View.aspx?cat=317&case=1256
10. Normal and abnormal axillary lymph node
Normal:

http://www.ultrasoundcases.info/Slide-View.aspx?cat=315&case=3919
abnormal:

http://ultrasound-images.blogspot.com/2010/09/breast-cancer-with-spread-to-lymph.html
For questions 11-20, use the resources found in your Breast Learning Module on Moodle as
reference tools:

Find images that correlate with the following pathologies. Copy and paste the
images into this document - provide the url with the image.
Identify one clinical finding associated with each pathology

11. Ductal carcinoma in situ

http://e-sciencecentral.org/articles/SC000001386
Clinical finding: nipple discharge
12. Invasive ductal carcinoma

http://www.ultrasoundcases.info/Slide-View.aspx?cat=615&case=6015
Clinical finding: nipple retraction. Increased amount of lymph node involvement.

13. Lobular carcinoma

http://radiopaedia.org/cases/invasive-lobular-breast-carcinoma
Clinical finding: spiculated mass. Presents as a distinct tumor.
14. Galactocele

http://radiopaedia.org/cases/galactocele-2
Clinical finding: mass in subareolar area. Cystic area with internal debris.
15. Acorn Cyst

http://www.learningradiology.com/radsigns/radsignspages/A-radsigns.htm
Clinical finding: Complex cyst where echogenicity within the cyst is due to fat and protein cells
16. Mastitis

http://www.ultrasoundcases.info/Slide-View.aspx?cat=302&case=1144
Clinical finding: thick, sticky discharge. Edema.
17. Fibroadenoma

http://openi.nlm.nih.gov/detailedresult.php?img=2766883_IJRI-19-242-g005&req=4
Clinical finding: non-tender palpable mass. Smooth rounded margins.
18. Phyllode

http://posterng.netkey.at/esr/viewing/index.php?module=viewing_poster&task=viewsection&
ti=352507
Clinical finding: mass or quick appearance of large breast. May appear cystic.
19. Hamartoma

http://www.ultrasoundcases.info/Case-List.aspx?cat=299
Clinical finding: Non-palpable to soft/firm movable mass. Well defined heterogeneous mass
with or without shadowing.
20. Fat Necrosis

http://www.ultrasoundcases.info/Slide-View.aspx?cat=450&case=1994
Clinical finding: spherical nodule. Irregular with distal shadowing.