DOI: 10.1148/rg.27si075510
Breast Lesions Incidentally Detected with CT: What the General Radiologist Needs to Know1
Monica G. Harish, MD2,
Sheela D. Konda, MD, PhD2,
Heber MacMahon, MB, BCh, and
Gillian M. Newstead, MD
1 From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637. Presented as an education exhibit at the 2006 RSNA Annual Meeting. Received March 6, 2007; revision requested March 29 and received May 9; accepted May 16. H.M. is a stockholder in R2 Technology, consults for Riverain Medical and MEDIAN Technologies, and receives research support from R2 Technology, Mitsubishi Space Software, General Electric, and Eastman Kodak; G.M.N. is a member of the speakers bureau for Fuji Photo Film and the advisory board for Konica Minolta; all other authors have no financial relationships to disclose.
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Figure 1a. Invasive ductal carcinoma. (a–c) Axial (a) and coronal (b) nonenhanced CT scans and mediolateral mammogram of the left breast (c) show a spiculated, dense, ill-defined mass (arrow in c). (d) US image shows the hypoechoic mass with irregular margins and hypervascularity.
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Figure 1b. Invasive ductal carcinoma. (a–c) Axial (a) and coronal (b) nonenhanced CT scans and mediolateral mammogram of the left breast (c) show a spiculated, dense, ill-defined mass (arrow in c). (d) US image shows the hypoechoic mass with irregular margins and hypervascularity.
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Figure 1c. Invasive ductal carcinoma. (a–c) Axial (a) and coronal (b) nonenhanced CT scans and mediolateral mammogram of the left breast (c) show a spiculated, dense, ill-defined mass (arrow in c). (d) US image shows the hypoechoic mass with irregular margins and hypervascularity.
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Figure 1d. Invasive ductal carcinoma. (a–c) Axial (a) and coronal (b) nonenhanced CT scans and mediolateral mammogram of the left breast (c) show a spiculated, dense, ill-defined mass (arrow in c). (d) US image shows the hypoechoic mass with irregular margins and hypervascularity.
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Figure 2a. Invasive ductal carcinoma. (a, b) Axial (a) and coronal (b) contrast-enhanced CT scans show a rim-enhancing irregular mass. (c) Craniocaudal mammogram of the right breast shows that the dense mass (arrow) is ill defined anteriorly.
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Figure 2b. Invasive ductal carcinoma. (a, b) Axial (a) and coronal (b) contrast-enhanced CT scans show a rim-enhancing irregular mass. (c) Craniocaudal mammogram of the right breast shows that the dense mass (arrow) is ill defined anteriorly.
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Figure 2c. Invasive ductal carcinoma. (a, b) Axial (a) and coronal (b) contrast-enhanced CT scans show a rim-enhancing irregular mass. (c) Craniocaudal mammogram of the right breast shows that the dense mass (arrow) is ill defined anteriorly.
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Figure 3a. Invasive ductal carcinoma. Axial (a) and coronal (b) contrast-enhanced CT scans and craniocaudal mammogram of the left breast (c) show a spiculated mass (arrow) with associated nipple retraction and skin thickening.
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Figure 3b. Invasive ductal carcinoma. Axial (a) and coronal (b) contrast-enhanced CT scans and craniocaudal mammogram of the left breast (c) show a spiculated mass (arrow) with associated nipple retraction and skin thickening.
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Figure 3c. Invasive ductal carcinoma. Axial (a) and coronal (b) contrast-enhanced CT scans and craniocaudal mammogram of the left breast (c) show a spiculated mass (arrow) with associated nipple retraction and skin thickening.
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Figure 4a. Invasive lobular carcinoma. (a–c) Serial axial contrast-enhanced CT scans, displayed from cranial (a) to caudal (c), show a diffusely infiltrating enhancing area of opacity without a discrete mass (arrow in b). The nodular density lateral to the breast with calcification is likely a benign finding. (d) Axial CT scan of the opposite breast, obtained at the same level as b, shows the subtle asymmetry.
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Figure 4b. Invasive lobular carcinoma. (a–c) Serial axial contrast-enhanced CT scans, displayed from cranial (a) to caudal (c), show a diffusely infiltrating enhancing area of opacity without a discrete mass (arrow in b). The nodular density lateral to the breast with calcification is likely a benign finding. (d) Axial CT scan of the opposite breast, obtained at the same level as b, shows the subtle asymmetry.
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Figure 4c. Invasive lobular carcinoma. (a–c) Serial axial contrast-enhanced CT scans, displayed from cranial (a) to caudal (c), show a diffusely infiltrating enhancing area of opacity without a discrete mass (arrow in b). The nodular density lateral to the breast with calcification is likely a benign finding. (d) Axial CT scan of the opposite breast, obtained at the same level as b, shows the subtle asymmetry.
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Figure 4d. Invasive lobular carcinoma. (a–c) Serial axial contrast-enhanced CT scans, displayed from cranial (a) to caudal (c), show a diffusely infiltrating enhancing area of opacity without a discrete mass (arrow in b). The nodular density lateral to the breast with calcification is likely a benign finding. (d) Axial CT scan of the opposite breast, obtained at the same level as b, shows the subtle asymmetry.
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Figure 5a. Secondary lymphoma of the breast. (a) Contrast-enhanced CT scan shows bilateral marked axillary adenopathy (arrows). (b, c) Bilateral mediolateral mammograms show large dense masses (arrow) in the right (b) and left (c) axillae. The masses are due to lymphadenopathy from secondary lymphoma. (d) Contrast-enhanced CT scan of another patient shows skin thickening with palpable large, irregular masses. The masses demonstrate poor enhancement because the image is from the arterial phase of a pulmonary embolus study.
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Figure 5b. Secondary lymphoma of the breast. (a) Contrast-enhanced CT scan shows bilateral marked axillary adenopathy (arrows). (b, c) Bilateral mediolateral mammograms show large dense masses (arrow) in the right (b) and left (c) axillae. The masses are due to lymphadenopathy from secondary lymphoma. (d) Contrast-enhanced CT scan of another patient shows skin thickening with palpable large, irregular masses. The masses demonstrate poor enhancement because the image is from the arterial phase of a pulmonary embolus study.
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Figure 5c. Secondary lymphoma of the breast. (a) Contrast-enhanced CT scan shows bilateral marked axillary adenopathy (arrows). (b, c) Bilateral mediolateral mammograms show large dense masses (arrow) in the right (b) and left (c) axillae. The masses are due to lymphadenopathy from secondary lymphoma. (d) Contrast-enhanced CT scan of another patient shows skin thickening with palpable large, irregular masses. The masses demonstrate poor enhancement because the image is from the arterial phase of a pulmonary embolus study.
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Figure 5d. Secondary lymphoma of the breast. (a) Contrast-enhanced CT scan shows bilateral marked axillary adenopathy (arrows). (b, c) Bilateral mediolateral mammograms show large dense masses (arrow) in the right (b) and left (c) axillae. The masses are due to lymphadenopathy from secondary lymphoma. (d) Contrast-enhanced CT scan of another patient shows skin thickening with palpable large, irregular masses. The masses demonstrate poor enhancement because the image is from the arterial phase of a pulmonary embolus study.
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Figure 6a. Inflammatory carcinoma. (a) Contrast-enhanced CT scan shows an irregular, peripherally enhancing, solid mass with associated skin thickening. (b, c) Craniocaudal mammogram of the right breast (b) and US image (c) show diffuse infiltrative disease.
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Figure 6b. Inflammatory carcinoma. (a) Contrast-enhanced CT scan shows an irregular, peripherally enhancing, solid mass with associated skin thickening. (b, c) Craniocaudal mammogram of the right breast (b) and US image (c) show diffuse infiltrative disease.
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Figure 6c. Inflammatory carcinoma. (a) Contrast-enhanced CT scan shows an irregular, peripherally enhancing, solid mass with associated skin thickening. (b, c) Craniocaudal mammogram of the right breast (b) and US image (c) show diffuse infiltrative disease.
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Figure 7a. Inflammatory carcinoma. (a, b) Contrast-enhanced CT scans (a obtained at a higher level than b) show an irregular, peripherally enhancing, encapsulated, fluid density mass with thick septa and adjacent skin thickening. (c, d) Mediolateral mammogram of the right breast (c) and US image (d) show concordant findings (arrows in c).
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Figure 7b. Inflammatory carcinoma. (a, b) Contrast-enhanced CT scans (a obtained at a higher level than b) show an irregular, peripherally enhancing, encapsulated, fluid density mass with thick septa and adjacent skin thickening. (c, d) Mediolateral mammogram of the right breast (c) and US image (d) show concordant findings (arrows in c).
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Figure 7c. Inflammatory carcinoma. (a, b) Contrast-enhanced CT scans (a obtained at a higher level than b) show an irregular, peripherally enhancing, encapsulated, fluid density mass with thick septa and adjacent skin thickening. (c, d) Mediolateral mammogram of the right breast (c) and US image (d) show concordant findings (arrows in c).
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Figure 7d. Inflammatory carcinoma. (a, b) Contrast-enhanced CT scans (a obtained at a higher level than b) show an irregular, peripherally enhancing, encapsulated, fluid density mass with thick septa and adjacent skin thickening. (c, d) Mediolateral mammogram of the right breast (c) and US image (d) show concordant findings (arrows in c).
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Figure 8a. Inflammatory carcinoma. (a) Contrast-enhanced CT scan shows a solid, irregular, lobular mass (arrows) with surrounding edema of the breast. (b) US image shows the complex, lobulated, echogenic mass against the background of the edematous breast.
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Figure 8b. Inflammatory carcinoma. (a) Contrast-enhanced CT scan shows a solid, irregular, lobular mass (arrows) with surrounding edema of the breast. (b) US image shows the complex, lobulated, echogenic mass against the background of the edematous breast.
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Figure 9. Postoperative hematoma or seroma. Contrast-enhanced CT scan shows an irregular, peripherally enhancing mass with punctate foci of air (short arrows) and an air-fluid level (long arrow).
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Figure 10a. Postoperative hematoma or seroma. (a–c) Serial nonenhanced CT scans show a round postoperative fluid collection (a) that resolves over time (b), leaving a fibrous scar (c). (d) Corresponding craniocaudal mammogram of the right breast shows the irregular, spiculated, high-density mass (arrow) posterior to a linear scar marker.
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Figure 10b. Postoperative hematoma or seroma. (a–c) Serial nonenhanced CT scans show a round postoperative fluid collection (a) that resolves over time (b), leaving a fibrous scar (c). (d) Corresponding craniocaudal mammogram of the right breast shows the irregular, spiculated, high-density mass (arrow) posterior to a linear scar marker.
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Figure 10c. Postoperative hematoma or seroma. (a–c) Serial nonenhanced CT scans show a round postoperative fluid collection (a) that resolves over time (b), leaving a fibrous scar (c). (d) Corresponding craniocaudal mammogram of the right breast shows the irregular, spiculated, high-density mass (arrow) posterior to a linear scar marker.
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Figure 10d. Postoperative hematoma or seroma. (a–c) Serial nonenhanced CT scans show a round postoperative fluid collection (a) that resolves over time (b), leaving a fibrous scar (c). (d) Corresponding craniocaudal mammogram of the right breast shows the irregular, spiculated, high-density mass (arrow) posterior to a linear scar marker.
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Figure 11a. Postoperative scar. (a) Nonenhanced CT scan shows a spiculated dense mass. (b) Corresponding craniocaudal mammogram of the right breast shows an area of architectural distortion (arrow) that corresponds to the site of surgical scarring.
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Figure 11b. Postoperative scar. (a) Nonenhanced CT scan shows a spiculated dense mass. (b) Corresponding craniocaudal mammogram of the right breast shows an area of architectural distortion (arrow) that corresponds to the site of surgical scarring.
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Figure 13a. Postoperative scar. (a, b) Axial (a) and coronal (b) contrast-enhanced CT scans show an isolated finding of a spiculated, dense mass. (c) Corresponding craniocaudal mammogram of the left breast shows architectural distortion and surgical clips (arrow) in the area of an earlier lumpectomy.
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Figure 13b. Postoperative scar. (a, b) Axial (a) and coronal (b) contrast-enhanced CT scans show an isolated finding of a spiculated, dense mass. (c) Corresponding craniocaudal mammogram of the left breast shows architectural distortion and surgical clips (arrow) in the area of an earlier lumpectomy.
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Figure 13c. Postoperative scar. (a, b) Axial (a) and coronal (b) contrast-enhanced CT scans show an isolated finding of a spiculated, dense mass. (c) Corresponding craniocaudal mammogram of the left breast shows architectural distortion and surgical clips (arrow) in the area of an earlier lumpectomy.
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Figure 14a. Biopsy-proved fibroadenoma. (a) Contrast-enhanced CT scan shows an elliptical, well-defined, homogeneously enhancing mass without associated nipple retraction or skin thickening. (b) Craniocaudal mammogram of the left breast shows the circumscribed, lobulated, noncalcified mass (arrow). Postsurgical changes and surgical clips are seen in the retroareolar region. (c) US image shows the solid, circumscribed, parallel, hypoechoic mass.
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Figure 14b. Biopsy-proved fibroadenoma. (a) Contrast-enhanced CT scan shows an elliptical, well-defined, homogeneously enhancing mass without associated nipple retraction or skin thickening. (b) Craniocaudal mammogram of the left breast shows the circumscribed, lobulated, noncalcified mass (arrow). Postsurgical changes and surgical clips are seen in the retroareolar region. (c) US image shows the solid, circumscribed, parallel, hypoechoic mass.
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Figure 14c. Biopsy-proved fibroadenoma. (a) Contrast-enhanced CT scan shows an elliptical, well-defined, homogeneously enhancing mass without associated nipple retraction or skin thickening. (b) Craniocaudal mammogram of the left breast shows the circumscribed, lobulated, noncalcified mass (arrow). Postsurgical changes and surgical clips are seen in the retroareolar region. (c) US image shows the solid, circumscribed, parallel, hypoechoic mass.
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Figure 15a. Fibroadenolipoma. (a, b) Axial (a) and coronal (b) contrast-enhanced CT scans show an oval, circumscribed mass of mixed soft-tissue and fat density. (c) Craniocaudal mammogram of the right breast shows the fat and soft-tissue density mass with sharply defined margins.
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Figure 15b. Fibroadenolipoma. (a, b) Axial (a) and coronal (b) contrast-enhanced CT scans show an oval, circumscribed mass of mixed soft-tissue and fat density. (c) Craniocaudal mammogram of the right breast shows the fat and soft-tissue density mass with sharply defined margins.
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Figure 15c. Fibroadenolipoma. (a, b) Axial (a) and coronal (b) contrast-enhanced CT scans show an oval, circumscribed mass of mixed soft-tissue and fat density. (c) Craniocaudal mammogram of the right breast shows the fat and soft-tissue density mass with sharply defined margins.
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Figure 16a. Benign calcifications. (a–c) Axial (a, b) and coronal (c) contrast-enhanced CT scans show multiple coarse benign-appearing calcifications. (The calcifications shown in a and b are in the same breast. The one shown in a is more lateral; the one shown in b is more medial.) (d) Craniocaudal mammogram of the right breast shows several popcorn calcifications, which are consistent with hyalinized fibroadenomas.
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Figure 16b. Benign calcifications. (a–c) Axial (a, b) and coronal (c) contrast-enhanced CT scans show multiple coarse benign-appearing calcifications. (The calcifications shown in a and b are in the same breast. The one shown in a is more lateral; the one shown in b is more medial.) (d) Craniocaudal mammogram of the right breast shows several popcorn calcifications, which are consistent with hyalinized fibroadenomas.
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Figure 16c. Benign calcifications. (a–c) Axial (a, b) and coronal (c) contrast-enhanced CT scans show multiple coarse benign-appearing calcifications. (The calcifications shown in a and b are in the same breast. The one shown in a is more lateral; the one shown in b is more medial.) (d) Craniocaudal mammogram of the right breast shows several popcorn calcifications, which are consistent with hyalinized fibroadenomas.
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Figure 16d. Benign calcifications. (a–c) Axial (a, b) and coronal (c) contrast-enhanced CT scans show multiple coarse benign-appearing calcifications. (The calcifications shown in a and b are in the same breast. The one shown in a is more lateral; the one shown in b is more medial.) (d) Craniocaudal mammogram of the right breast shows several popcorn calcifications, which are consistent with hyalinized fibroadenomas.
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Figure 17. Lactating breasts. Axial contrast-enhanced CT scan shows symmetric hyperattenuating, linear soft-tissue densities in both breasts, an appearance consistent with engorged lactiferous glands.
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Figure 19. Breast CT lexicon: enhancement pattern. Contrast-enhanced CT scan of an inflammatory cancer shows enhancing internal septa (A) and rim enhancement (B). After administration of contrast material, the pattern of enhancement should be characterized.
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Figure 20. Breast CT lexicon: associated finding. Contrast-enhanced CT scan of an inflammatory cancer shows associated skin thickening (arrow). In addition to the breast mass, associated findings should also be mentioned.
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Copyright © 2007 by the Radiological Society of North America.
