Breast Midterm
Patient prep
none
6 sonographic layers of tissue in breast:
1) Skin 2) Premammary 3) Mammary 4) Retromammary 5) Muscle layer 6) Chest wall
3 layers of the breast:
1) Subcutaneous layer (premammary) 2) Mammary layer 3) Retromammary layer
Stand-off pads
Creates distance between face of probe and the skin surface. Improves imaging of superficial tumors,cysts and vessels
Axilla contains:
Axillary vessels and their branches, and it's branches and lymph nodes embedded in fatty tissue
Gynocomastia
Breast development in males
Main arterial supply to breast:
Internal mammary & lateral thoracic arteries
TDLU consists of :
Lobules & Ducts
Pectoralis Major Muscle
Located posterior to retromammary layer
Breast aka:
Mammary gland located between skin & pectoralis major muscle
Acini cells produce?
Milk
Exocrine gland primary function in the breast:
Milk secretion
Pituitary glands produce what?
Oxytocin and Prolactin
Hypothalamus produces what?
Prolactin inhibitors
Patient positioning for breast u/s exam
Supine, patients arm raised above their head with positioning aid placed under patients shoulder
Cooper's ligament
Supporting framework of the breast. Connective tissue in the breast that help maintain structural integrity. AKA: Suspensory ligaments
What is fascia? What are it's layer?
Surrounds all mammary tissues and seperates the breast into superficial and deep tissues. layers: -Superficial layer (w/i premammary layer -Deep layer (posterior to the mammary layer, w/i the retromammary)
What is the functional unit of the breast?
TDLU
_________ is the site most abnormalities arise (both malignant and benign)
TDLU
Where does each lobe empty is?
lactiferous ducts
U/S characteristics of a solid mass
-Mobility -Compressibility -Vascularity
Malignant breast mass includes?
-Solid -Heterogenous -Lobulated -Irreg. borders -Taller thsn wide -Complex
Glandular part of breast includes:
-Lobules and ducts *each breast has several ducts that lead out to the nipple
Axilla
(AKA: Tail of Spence) The part of the mammary tissue that extends into the upper outer quadrant and axilla area
Supporting tissue of the breast includes:
-Fatty tissue -Fibrous connective both give the breast its size and shape)
Breast screening indications:
-palpable mass -abnormal discharge -nipple discharge -younger women -prego/lactating -pain -US guided procedures -implants -intra/post ops
Skin thickness of the breast is:
0.5-2 mm
Breast anatomy consists of:
1) *Milk glands* (lobules) -produce milk 2) *Ducts* (lactiferous ducts) that transport milk from the milk glands (lobules) to the nipple. 3) *Nipple* (aka ampulla) 4) *Areola* 5) *Connective (fibrous) tissue* that surrounds the lobules and ducts 6)Fat
Nipple is composed of :
1) 15-20 networks of ducts that converge on the nipple 2) Erectile tissue & small excretory ducts to drain milk
Breast tissue changes with:
1) Puberty 2) Pregnancy 3) Premenopausal 4) Postmenopausal
2 main types of breast tissue
1.) Glandular 2.) Supporting (stromal)
Mammary gland contains how many sections?
12-20 sections
how many lobes in each breast or mammary gland?
15-20 lobes
Milk production usually begins within_________ post partum
2-3 days
Glandular tissue comprises _________ of the breast tissue
2/3
How many TDLU's does each lobe contain?
20-40
Transducer choice for breast U/S?
5-18 MHz *linear*
Normal ducts in a *non-lactating* female should measure _______ in diameter and ________ in size closer to the nipple.
<2mm;increase
Normal *lactating* female should measure ____________ in diameter
<8mm
Polymastia
Accessory breast tissue *most common site is in the axilla
How does the breast tissue change in pregnancy?
Acinar cells stilmuated by prolactin to produce milk while oxytocin causes ductal contractions during infant suckling. Breast enlarge due to engorgement of ducts with milk
Smallest functional unit of the breast is :
Acini layer
u/s appearance of Parenchyma/ glandular tissue:
Dense echogenic pattern
What collects milk from the acini cells?
Ducts
How does the breast tissue change in puberty?
Estrogen and progesterone stimulate development
Amastia
Failure of the breast and nipple development
Mammary layer is also called:
Fibroglandular or parenchymal layer *Central layer *Contains lobes, ducts, lobules, and *acini*
How does the breast tissue change in postmenopausal?
HRT can cause glandular tissue to increase
u/s appearance of Cooper's ligament:
Highly echogenic linear structure
How does the breast tissue change in Premenopasual?
Hormone levels *decrease* glandular tissue shrivel and fat levels *increase*
u/s appearance of Muscle:
Hypoechoic
u/s appearance of Fat:
Hypoechoic to parenchymal breast tissue
Scanning planes for the breasts are:
Radial & antiradial
Most common palpable finding that is mistaken for a mass
Rib
3 layers posterior to pectoralis muscles:
Rib, Pluera and Lungs
Whole Breast survey
Scanning the breast in question at the 12 o'clock position. *Transducer orientation is set up so that the breast is viewed sectiond from the nipple outward, where the orientation notch is located.
Areola
Small pigmented skin that encircles the nipple; composed of smooth muscle tissue is called areola
Venous drainage provided mainly by
Superficial veins
Advantage to scanning radially is ?
To avoid artifacts from the cooper's ligament & bc it is the scan plane of the ductal system for solid lesion
U/S appearance of the breast changes with:
age
Mammary layer differs in ________ with age
appearance
After birth estrogen & progesterone levels __________ and proclactin & oxytocin levels ___________ to stimulate milk production
decrease; increase
u/s appearance of skin:
echogenic line
Ovaries produce what ?
estrogen & progesterone
What happens to glandular tissue and fatty tissue during postmenopausal?
glandular tissue-decreases fatty tissue-increases
The breast tissue extends ___________ from the sternum
medially
#1 congenital anomaly in both females and males
polythelia aka accessory nipple
Subcutaneous layer is also called:
premammary layer
