Diagnostic ultrasound ( PDFDrive )

CHAPTER 21 The Breast 801
A
B
C D E
FIG. 21.61 Lesions Other Than Papillomas That Cause Nipple Discharge. Duct ectasia usually involves one lobar ductal system at a time.
(A) Early in its course, only a single duct might be involved. (B) Over time, additional lobar ducts can become involved, leading to multiple dilated
ducts. When all the ducts are severely involved, one must consider hyperprolactinemia as an underlying factor. (C) Communicating cysts. (D)
Conirmation that the cyst truly communicates with the ductal system can be made by showing a “color-swoosh” with the communicating duct
when the cyst undergoes ballottement with the transducer. (E) Pure ductal carcinoma in situ (DCIS) and invasive duct carcinomas that have DCIS
components can also give rise to nipple discharge.
A
B
D
E
Location or Position Correlation
Because mammographic compression pulls a lesion away from
the chest wall and sonographic compression pushes the lesion
closer to the chest wall, lesions usually appear much closer to
the chest wall on sonography than on mammography. Lesions
that appear to lie several centimeters from the chest wall on
mammography may appear to lie very close to the chest wall,
even indenting the chest wall musculature, on sonography. If
this routine apparent diference in depth of lesions on mammography
and sonography is not understood, the clinician might
falsely conclude that the sonographic lesion lies too deep to
correspond to the mammographic lesion.
C
FIG. 21.62 Importance of Mammographic-Sonographic Correlation.
Everything that is water density could contribute to the size of the
mammographic lesion. Thus a 3-cm, ovoid, circumscribed mammographic
mass could represent (A) a cyst, or (B) a solid nodule, surrounded
by a thin echogenic capsule; (C) 3-cm collection of interlobular stromal
ibrous tissue; (D) 3-cm cyst containing a mural nodule; or (E) smaller
cyst, or (F) solid nodule, surrounded by ibrous or glandular tissue.
F
Surrounding Tissue Density Correlation
he inal step in correlating the sonographic and mammographic
indings is assessment of the density of surrounding tissues. A
lesion that protrudes into the subcutaneous fat from the mammary
zone, and that is surrounded by fat supericially and water density
tissue along its deep margins on the mammogram, should lie at
the junction of the subcutaneous fat and mammary zone on the
sonogram. It should be surrounded by subcutaneous fat along
its supericial margin and by either hyperechoic ibrous tissue
or isoechoic glandular tissue along its deep border on the
sonogram (Fig. 21.65).