IS Case 302: Infiltrating ductal carcinoma incidentally detected on chest CT

Ahmed El-Sherief, MD

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Imaging Sciences URMC 2009
Publication Date: 2009-08-05

History

Patient is an 88-year-old female with a solid/cystic breast mass incidentally detected on chest CT performed as work-up for a suspect lung mass.

Findings

Solid/cystic left breast mass.

Diagnosis

Infiltrating ductal carcinoma incidentally detected on chest CT

Discussion

Breast abnormalities at CT are frequently overlooked or inaccurately assessed [1].

CT characterization of breast masses includes description of:

• Shape
• Density
• Pattern of enhancement
• Associated findings

Features of breast malignancy:

• Irregular margins and shape
• Rim enhancement

CT findings:

• Invasive ductal carcinoma: dense, spiculated mass with marked early and/or peripheral enhancement
• Invasive lobular carcinoma: non-specific (ranges from asymmetric soft-tissue density +/- associated skin thickening to a mass)
• Inflammatory breast carcinoma: similar imaging findings to a mastitis or an abscess; but clue is that it fails to respond to antibiotics
• Fibroadenoma: circumscribed, round/oval masses +/- coarse popcorn-like calcifications
• Fibroadenolipoma: circumscribed, mixed-density lesion with macroscopic fat
• Calcifications: “nearly all calcifications currently seen at CT are benign, on the basis of size alone, due to the limited spatial resolution”

References

1. Harish MG, Konda SD, MacMahon H, Newstead GM. Breast lesions incidentally detected with CT: what the general radiologist needs to know. Radiographics. 2007 Oct;27 Suppl 1:S37-51. PMID: 18180233 [PubMed]