Traumatic Breast Changes

Question 1

What are 5 examples of traumatic changes to the breast?

Answer 1

1. Contusion or hematoma
2. Fat necrosis
3. Seroma
4. Scarring
5. Skin thickening

Question 2

What is the most common type of trauma to the breast? Results in?

Answer 2

1. Blunt trauma
2. Bruise

Question 3

What is the 2nd most common type of trauma to the breast? From what?

Answer 3

1. Nipple fissures
2. Nursing

Question 4

Fat Necrosis Tumour

Answer 4

Destruction of fat cells in the breast due to trauma or injury that can cause a hard noncancerous lump

Question 5

What does fat necrosis look like on US? (3)

Answer 5

1. Hyperechoic mass
2. Central hypoechoic to anechoic components
3. Surrounding edema

Question 6

What type of Pt is fat necrosis more common in?

Answer 6

Obese women with large breasts

Question 7

How does fat necrosis happen?

Answer 7

After surgery or trauma, the blood supply to fat cells may be compromised by excessive swelling, pressure from the hematoma, or congestion in the surgical area
- causing some fat cells to die and release particles of fat into surrounding tissue

Question 8

What kind of appearance can happen for fat necrosis on mammo?

Answer 8

Egg shell appearance

Question 9

What is a result of fat cells dying and their contents are released forming a sac like collection of greasy fluid?

Answer 9

Oil cysts

Question 10

What is the most common form of fat necrosis?

Answer 10

Oil cysts

Question 11

What is the end stage of fat necrosis?

Answer 11

Oil cysts

Question 12

What can oil cysts mimic?

Answer 12

Carcinomas

Question 13

How can oil cysts appear on US? (3)

Answer 13

1. Firm
2. Shadowing
3. Irregular mass

Question 14

What are oil cysts associated with? (2)

Answer 14

1. Skin retraction
2. Architectural distortion

Question 15

Seroma

Answer 15

Clear fluid trapped in a wound

Question 16

What is common to form after breast surgery?

Answer 16

Seroma

Question 17

What is the most post surgical complication for the breast?

Answer 17

Seroma

Question 18

What % do seromas develop after sugery?

Answer 18

50-60% incidence rate

Question 19

What happens to seromas? After how long?

Answer 19

1. Gradually absorbed by the body
2. Usually takes 1 year

Question 20

How do seromas appear on US?

Answer 20

1. Oval
2. Well circumscribed
3. Thick walled
4. Complex cystic mass

Question 21

Skin retraction

Answer 21

Concave skin surface or a skin surface that appear ill defined and pulled in

Question 22

What is a common complication of surgery for the skin? (2)

Answer 22

1. Scarring
2. Skin thickening

Question 23

What % of Pts experience skin thickening post surgery?

Answer 23

20%

Question 24

What are scars replaced with post sugery?

Answer 24

Fluidow

Question 25

How long does it take fluid to replace scars post surgery?

Answer 25

6-18 months

Question 26

Why are scars highly monitored?

Answer 26

Higher recurrence rate

Question 27

How long does it take for calcifications to potentially show up after sugery?

Answer 27

6 months

Question 28

How long does it take for reoccurrence to occur at the original site of sugery?

Answer 28

2-7 years

Question 29

What are the measurements for a normal skin line?

Answer 29

Less than 2mm

Question 30

What are 7 causes for skin thickening?

Answer 30

1. Carcinoma 2. Trauma 3. Inflammation and associated edema 4. Venous obstructing 5. Lymphatic obstruction 6. Congestive heart failure 7. Nephrotic syndrome

Question 31

Radial scar

Answer 31

Sclerosing duct hyperplasia or complex sclerosing lesions

Question 32

What are radial scars not related to?

Answer 32

Previous trauma or surgery - etiology unknown

Question 33

Are radial scars benign or malignant?

Answer 33

Typically benign

Question 34

How does a radial scar show up on US?

Answer 34

Spiculated lesion with or without calcification

Question 35

How does a radial scar show up on mammo?

Answer 35

On a mammo they show up as stellate or spiculated with a central lucent core

Question 36

What is the tricky thing with radial scars?

Answer 36

Normally seen best in one plane but not the other on mammo

Question 37

When can radial scars become malignant?

Answer 37

When they are greater than 2cm

Question 38

What are radial scars called after they become 10mm or larger in size?

Answer 38

Complex sclerosing lesions

Question 39

What is Mondor's disease?

Answer 39

Thrombophlebitis of the subcutaneous veins of the breast

Question 40

What are the most commonly affected veins in Mondor's disease? (2)

Answer 40

1. Lateral thoracic veins 2. Thoraco-epigastric veins

Question 40

What does Mondor's disease present with? (5)

Answer 40

1. Tenderness 2. Pain 3. Skin retraction 4. Cord like mass 5. Skin thickening

Question 41

How does Mondor's disease present on mammo?

Answer 41

Beaded subcutaneous vein - string of beads

Question 42

How does Mondor's disease present on US? (2)

Answer 42

1. Hypoechoic thrombosed vein 2. Non-compressible

Question 43

Diabetic Fibrous Mastopathy

Answer 43

Uncommon condition causing breast masses that are usually seen in pre-menopausal women with long-standing type 1 (insulin dependent) diabetes mellitus

Question 44

What is diabetic fibrous mastopathy caused by? Secondary to?

Answer 44

1. An immune reaction to material deposited in the breast 2. Secondary to elevated blood glucose levels

Question 45

What are common things to have when a Pt has diabetic fibrous mastopathy? (4)

Answer 45

1. Single or multiple firm hard lumps 2. Ill defined borders 3. Non tender 4. Easily movable without fixation to the skin

Question 46

How does diabetic fibrous mastopathy show up on US? (5)

Answer 46

1. Solid 2. Homogenous 3. Hypoechoic 4. Attenuating mass 5. Some shadow