Diagnostic ultrasound ( PDFDrive )

CHAPTER 21 The Breast 803
*
*
A
B
8 3B TRN
Right breast
N + 5
Ques area on mamms
FIG. 21.65 Mammographic-Sonographic Correlation of Surrounding Tissue Density. (A) Mammogram shows a nodule projecting between
two Cooper ligaments (arrowheads) and bulging anteriorly into the subcutaneous fat (arrow) from the mammary zone (*). (B) Sonogram shows
that the mammographic nodule is a small cyst that protrudes out of ibrous tissue in the mammary zone (*) and into the subcutaneous fat (arrow).
It lies between two Cooper ligaments (arrowheads).
Sonographic-Mammographic Conirmation
Correlating size, shape, location, and surrounding tissue density
will allow the mammographic and sonographic indings to be
deinitively correlated in most cases, but in some cases may fail.
If it cannot be determined with absolute certainty that the mammographic
and sonographic lesions are indeed the same, minimally
invasive sonographic procedures can be performed to conirm
the correlation. If sonography shows the suspect mammographic
lesion to be cystic, ultrasound-guided cyst aspiration can be
performed and the mammogram repeated to see if the mammographic
lesion has disappeared. If sonography shows the
suspect lesion to be solid, ultrasound-guided placement of a
small-gauge needle (e.g., 25 gauge) or removable wire can be
performed and the mammogram repeated with the needle or
wire in place, to document that the sonographic lesion and
mammographic lesion are indeed in the same lesion. Alternatively,
an ultrasound-guided core biopsy can be performed with placement
of a radiopaque biopsy marker in the sampled area.
Subsequent postprocedural mammography can conirm whether
the lesion that underwent biopsy and the initially seen inding
are the same.
NICHE APPLICATIONS FOR
BREAST ULTRASOUND
Infection
he main uses of sonography in patients with mastitis is to
determine whether there is an abscess, to determine its maturity,
to determine if it is multiloculated, and to guide aspiration of,
or drain placement into, the abscess in appropriate cases. he
appearance of abscesses varies depending on whether the mastitis
is puerperal or nonpuerperal and whether it is centrally or
peripherally located. 49,63-65 Peripheral abscesses in puerperal
Tender/redness site
Nursing x 7 wks
FIG. 21.66 Peripheral Puerperal Abscess. Often arising within
preexisting galactoceles, peripheral puerperal abscesses (calipers) have
very irregular walls and mixtures of luid and echogenic debris.
mastitis usually arise in preexisting galactoceles (Fig. 21.66) and
may contain milk by-products, whereas peripheral abscesses in
nonpuerperal mastitis oten arise within inlamed cysts. Central
abscesses, whether arising from puerperal or nonpuerperal
mastitis (Fig. 21.67), usually result from rupture of an inlamed
or infected duct and tend to be elongated in a plane that is parallel
to the inlamed duct. Initially, unilocular abscesses can be treated
with sequential ultrasound-guided aspirations. If they continue
to re-collect, infectious abscesses may require placement of a
percutaneous drain or surgical drainage. However, some noninfectious
collections such as those seen with granulomatous mastitis
may not beneit from continued aspirations because this can
result in istula formation. Biopsy may be necessary to conirm
this alternate diagnosis. In these scenarios, treatment may involve
antibiotic or steroid therapy or surgical excision. In some cases,