Case # 1                                       <<Back    Next>>

55 year old female with history of left lower inner quadrant malignant lumpectomy > 10 years ago, now with mammographic change at 12:00 position. No history of recent trauma.
 
Mammogram


MLO


Spot compression
Mammogram: An irregular area has increased in density and size within the posterior upper outer quadrant measuring approximately 6 x 2 cm, containing a coarse benign-appearing calcification & questionable faint microcalcifications.

Ultrasound: Irregular heterogeneous hyperechoic tissue located between 12 o'clock to 1 o'clock peripherally with patchy area of shadowing, spiculated margins extend to the dermis. No discrete mass.
Sagittal T2W FS Axial T1W FS post gad
MRI: Ill-defined mass with progressive enhancement, 12 o'clock position of the left breast. Fat suppression is inhomogeneous due to an adjacent surgical clip. Enhancement is best demonstrated on subtraction images.
Subtraction


First post-enhancement phase


Third post-enhancement phase
Diagnosis: Fat necrosis, granulation tissue, fibrosis (confirmed with open biopsy)
In this case, the mammographic change alone necessitated biopsy. The mass-like focal enhancement of fat necrosis was unsuspected. 
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