Breast duct ectasia us mammogram mri

Breast mammogram ultrasound lipoma, oil cyst, galactocele intramammary lymph node in UOQ hamartoma Simple cyst (typical) calcification Surgical scar Breast implants, scirrhous carcinoma lobular carcinoma Skin calcifications vascular calcifications Sutural Dystrophic popcorn Large Rodlike rim Round/punctuate Fat necrosis Milk of calcium Fibrocystic FCC fibroadenomas Fat necrosis with oil cyst mastitis with Abscess Haematoma atypical ductal hyperplasia Intracystic papilloma ductal carcinoma in situ, invasive ductal carcinoma BIRAD

1. ALL THINGS
BREAST ULTRASOUND
BREAST MAMMOGRAPHY

Dr Ahmed Esawy MD

2. ÁmDs3 pauyyv JG

Normal ducts diameter are 1-3 mm
not have focal areas of dilatation along its course

3. Areola

Anatomy of the breast and its ductal system

4. Duct Ectasia :
duct is typically larger than 2 mm in diameter or the

ampullary portion is greater than 3 mm in diameter

ÁmDs3 pauyyv JG

5. Dr Anmed Esawy

6. Dr Anmed Esawy

7. asyimetic

4

suspicious

subareolar

benign

ÁmDs3 pauyyv JG

8. Dr Esawy

9. Dr Esawy

10. Side : Bilateral

Site : Subareolar
Contents : no contents
Surrounding Periductal mastitis

ÁmDs3 pauyyv JG

11. Side: unilateral asymmetric
Site : Non-subareolar location
may be peripheral (away from the retroareolar region)

ÁmDs3 pauyyv JG

Wall: overall irregularity of the duct margin
ill-defined margin ,indistinctness
focal ductal wall thickening

Contents : Hypoechioc intraluminal contents

adjacent hypo echoic tissue

12. Side : Solitary duct ectasia
Wall : thickened

irregular

Focal dilatation
Shape : Asymmetric
Contents :Solid parenchymal mass
Surrounding hypoechogenicity seen

ÁmDs3 pauyyv JG

13. Dr Ahmed Esawy

14. Dilated ducts, one of which is filled with formed low
level internal echoes, representing a an intraductal
Carcinoma arising from a branch (arrows)

ÁmDs3 pauyyv JG

15. A subareolar dilated duct filled
with a focal hypoechoic nodule
of medium-level echogenicity
papilloma (arrow)

ÁmDs3 pauyyv JG

16. Dr

sawy

17. Duct ectasia

Sclerosing adenosis

Cysts and/or fibrosis (associated findings)
Apocrine metaplasia (associated findings)

ÁmDs3 pauyyv JG

18. Ja

n
Epithelial hyperplasia
Atypical ductal hyperplasia

Intraductal papilloma
Intraductal carcinoma

19. Ja

wn
Duct ectasia with inflammatory change fe)
ae 5 DCIS
Ductal epithelial hyperplasia id, a
Infiltrating ductal carcinoma ID:

Fibrocystic change is 5
Mucinous carcinoma

Papilloma
ADH (atypical ductal hyperplasia)

Sclerosing adenosis

20. location

Border

length
Morphology
margin

Micro calcification

Surrounding
hypoechogenicity

ductal wall
contents

DUPLEX

Mostly central

Clear

Less than 1 cm

Regular

Well defined

Absent

If present in periductal mastitis

thin
Inspissated secretion ,clotted
blood

No flow or minimal periductal

Mostly peripheral
Unclear

Larger than 1 cm
Irregular

Ill defined
Present

present

thickening

Mass attached to wall .no move
in changing position
Flow in mass

21. The differential diagnosis for an intraductal mass

inspissated secretions
Infection

Hemorrhage

solitary or multiple papillomas
malignancy (DCIS IDC)

most disease arising in the TDLU

ÁMDS3 pauwyy JG

22. AMDSZ peuuuy J

Untreated duct ectasia —— > obliteration of the
breast ducts ———» abscess formation.

ducts dilate ——> contain cholesterol crystals,
calcification, and protein ———» _ inflammatory
reaction ——> nipple discharge.

23. Dr Esawy

24. Dr Anmed Esawy

25. Dr Esawy

26. Ja

sy

27. Benign ductal Diseases

ÁMDS3 pauwyy JG

28. ‘ductal ectasia with debris on it
freely movable Not attaches to wall , diffuse

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29. Dilated ducts secondary to benign duct ectasid ina patient with pain behind the nipple and
in the retroareolar region. US images of the left breast, obtained at the 3-0'clock position, show tubular
anechoic areas (arrowheads) behind the nipple (a) and in the retroareolar region (b). N in b = nipple

30. well defined duct ectasia with intraductal homogeneous echogenecity (arrows) in the subareolar
area of the left breast.

An echogenic intraductal nodule (arrowhead) is shown
no evidence of intraductal calcification

31. benign duct ectasia

CC Mammogram show radiodense tubular structures
(arrow) converging toward the nipple in the anterior
and slightly superior right breast

Amps3 pPaWUY Jd

32. jal MRI of breasts shows hyperintense
tine ectatic ducts

Bilateral Severe
Mammary Duct

Ectasia

multiple dilated branching ducts. no
associated microcalcifications

33. US image shows anechoic tubular structures extending
toward the nipple, findings that correspond to dilated
ectatic ducts. Note the focal areas of dilatation (arrows)

Duct ectasia. (a, b) vo (a)
and spot compression MLOXb)
mammograms show radio: se

tubular structures convergit
toward the nipple in the anterior
and slightly superior right bri
(arrows in b).

—

34. GE à E. À
tissue surrounding the dilated
which contain echogenic debris ducts is hypervascular

35. Duct ectasia with inflammatory infiltrates in woman. MLO (a) and craniocaudal (b)

DE with Inflammatory Infiltrates

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36. DE with Inflammatory Infiltrates

magnified craniocaudal mammogram (e) show
focal ductal dilatation with well-circumscribed
tubular encapsulated-appearing masses (arrow in ¢)
in the upper outer quadrant of the right breast

37. a -
focal ductal dilatation, There are soft-tissue nodules no associated flow within the masses

(arrows in d) within the duct, which correspond to
the masses seen at mammography.

Amps3

DE with Inflammatory Infiltrates

38. palpable or nonpalpable suspected ductal processer
lesion =

US evaluation is critical for correct diagnosis of
inflammatory infiltrates

ÁMDS3 PSWUY

Percutaneous biopsy is often required to exclude a
malignant cause

39. tetroareolar region show a 7-mm cyst with multiple tiny septa
dilated ducts and adjacent cysts that may contain inspissated secretions

Apocrine metaplasia in a woman with a history of bilateral milky nipple
discharge and subsequent bloody nipple discharge from a duct

40. Papillomas

Typically, they are located within a few centimeters of the
nipple and grow within the duct

asymptomatic or manifest as serous or sanguineous nipple
discharge

increased upgrade
potential include lesion size greater than 1 cm
lesion location more than 3 cm from the nipple
patient age greater than 50 years

Most institutions warrant surgical excision for CNB papilloma

ÁMDS3 pauwyy JG

41. RL
>
Papilloma in a woman with spontaneous nipple discharge

retroareolar region at the 12-0'clock position show dilated ducts
and a solid intraductal mass (arrow)

Pathologic intraductal papilloma

42. + MAMMOGRAMot least three no

rows) in the pe ”
anterior and posterior LEFT bi y yu

e
#4 DA Papillomatosis

a

43. Papilloma. Mammography shows a round, hyper dense
lesion with not well demarcated margins that is located
more than 3cm from the nipple

ÁmDs3 pauyyv JG

44. Mammographic s fatt surrounding
benign lesions that displace fat by their mass effect
rather than invading surrounding fatty tissue
(arrowheads) — pe:

tubular structure/asymmetric ductal d
nonsubareolar location (arrows) Im

a
E a mo
anechoic dilated Socle regul
contours that measure 2 cm (cal )
— - -

45. multiple papillomas tend to occur in distal ducts in the TOL

>

They are more often associated with =
Hyperplasia 2

Atypia m

DEIS ro}

invasive cancer 3

sclerosing adenosis
radial scars

46. Malignant ductal Diseases

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47. Dr

sawy

48. seal

US image shows a dilated duct containing an hypoechoic intraductal mass with arterial flow

49. ÁmDs3 pauyyv JG

A =
ss comedo type DCIS ne =

ill defined duct ectasia filled with intraductal heterogeneous echogenecities and intraductal

nodules in the peripheral portion
associated ductal wall thickening (arrows).

50. mucinous carcinoma with infiltrating ductal components

several aggregated cysts with ill-defined duct ectasia are noted in the peripheral ducts
Intraductal heterogeneous hypoechogenicities with ductal wall thickenings (arrows)
Surrounding hypoechoic parenchymal change (arrowheads)

ÁmDs3 pauyyv JG

51. dilated hypoechoid tubular
structures (arrow) th
several isoechoic 6).
hyperechoic intraductal foci
(arrowhead) wn

segmental
left breast, ext

52. Bilateral mammograms show a 4-
cm segment of asymmetrically
dilated ducts in the upper inner
quadrant of her right breast
(arrows).

overall indistinct structure of the
ductal walls irregular, serpiginous
shape

No suggestive calcifications or
discrete masses

ductal structures inthe right breast
branching, irregular, serpiginous hypoechoic ductal structures with internal
echogenicity that extend toward the upper inner aspect of the breast (arrows)

53. Typically DCIS manifests as calcifications at mammography

4% of cases it may manifest as a solid mass with or withouß
associated calcifications

ÁMDS3 pa

54. ESOO po e mass (cursors),
in a dilated duct (arrow). The mass
conteins multiple punctate echogenic
foci, a finding suspicious for

DC IS in woman with

a 2-week history of new-
onset nipple discharge

small focus of pleomorphic
microcalcifications (arrow) in
the retroareolar region

55. large irregul

mass with
echotextu
nipple
za #4 :
focal asymmetry with associated distortion in the =
central upper right breast, a finding that corresponds pe 4

to the area of concern as indicated by the patient. e

56. MR imaging with contrast material diagnose
several occult malignancies in the setting of
sanguineous nipple discharge

Although negative imaging work-up for nipple
discharge

ÁMDS3 pauwyy JG

57. high-nuclear-grade ductal carcinoma in

situ (DCIS) of the solid and pbpillary
types with associated sec
focal necrosis

mi - —
US image shows a dilated duct (arrow)
filled with hypoechoic material
containing a few isoechoic-hyperechoic
foci (arrowhead

Color Doppler image shows periductal hypervascularity

58. Ultrasound features of mammary duct ectasia. (A) Ultrasound-identified pipe-like hypo
echo under the right nipple (arrow) with clear border. (B) Color Doppler flow imaging identified
weak blood signals. Arrow indicates the thick dotted echo and cloddy hyper echo

59. IDC not intraductal papilloma.

Invasive ductal carcinoma misdiagnosed as Color Doppler flow imaging identified no
intraductal papilloma using US. (A) Solid blood signal. US diagnosed intraductal
nodules and dilated duct under the right papilloma.

nipple with smooth and clear pipe wall

60. Intraductal papilloma diagnosed using US with MRI. 2 Series yes echo sel “lies
(A) US identified a hyper echo nodule with dilated uct Under the nipple [arrow] and clear border.
a Color Doppler flow imaging identified no blood
duct above the nipple (arrow). = # = à
signal. US diagnosed intraductal papilloma

Pathology diagnosed intraductal papillary carcinoma

61. MRI

normal ducts are not typically visible, they intersperse with the
background breast parenchyma >

ducts are dilated non-enhanced T1-weighted images as ne
signal-intensity branching tubular structures an appearance due
to proteinaceous or sometimes hemorrhagic material in its
interior

Amos

Usually no associated enhancement with contrast medium

62. Papilloma. MR Sagittal contrast-enhanced fat-
saturated Tl-weighted
enhancing ovoid lesion (arrow) near the nipple

ÁmDs3 pauyyv JG