Chapter 16

Sonography ______ MHz linear array per ACR and AIUM guidelines

10-12

The parenchyma (fibroglandular) layer of the breast contain _______ overlapping lobes•

15-20

Each lobe contains ______ terminal ductolobular units (TDLU) aka lobules•

20-40

TDLU are made up of ______ Acini cells•

30-50

Sonography is useful for differentiating cystic from solid lesions• Used in interventional and therapeutic procedures• Better for dense breast• Can be used to evaluate the male breast•

True

Scanning Use of a standoff pad or extra gel to improve delineation of the skin and superficial breast•

True

are the functional units of the breast (where milk is produced)

Acini cells/TDLU

Gynecomastia•

Benign enlargement of the male breast•

The breast tissue is attached to the skin by ___________

Cooper ligaments

Retromammary layer/Retromammary zone•

Deepest layer• Contains fat• Typically hypoechoic

Gynecomastia•

Enlargement or swelling of breast tissue in males

Mammary layer/Mammary Zone/Parenchymal (fibroglandular) layer •

Functional layer of the breast• Contains the ducts and glandular tissue• Sonographic appearance based on many factors• Age• Distribution of fat•

Mastitis•

Inflammation of the breast due to infection• Most often during pregnancy and lactation • Can affect woman at any stage of life• Caused by staphylococcus or streptococcus organisms• Staph infections: germs under the skin• Strep infections: contact with discharges from the nose and throat of infected people •

Abscess•

Localized area of pus and necrotic tissue that develop in patients with infection•

Galactocele•

Milk filled cysts in lactating patients•Can develop after abrupt termination of breast feeding•May result from an obstruction of the lactiferous duct(s)•Appear as a round mass with well defined boarders• May be complex or contain fluid-fluid levels

Dilated lactiferous ducts• Clinical findings•

Pain• Swelling• Warmth and redness• Enlargement of the lymph nodes

Subcutaneous Layer/Subcutaneous Zone/Premammary layer•

Superficial layer• Composed mostly of fat• Typically hypoechoic•

Role of Breast Sonography• Useful in complimenting physical exam, mammography, and MRI• Low cost•

True

External surface• Skin• Nipple• Areola• The small bumps in the areola mark the sites of sebaceous glands (Montgomery glands)•

They secrete an oily substance to lessen drying and cracking of the nipple during breastfeeding•

Abscesses most often the form beneath the nipple• Subareolar

True

Abscesses• Clinical findings• Warmth/redness• Elevated WBC• Painful palpable lump

True

Acini cells/TDLU; Most benign and malignant breast diseases are from these structures•

True

Gynecomastia Most commonly presents at birth, after puberty, and between 50-80•

True

Gynecomastia is associated with• High levels of hCG• Testicular tumors• Hepatoblastoma (liver cancer)• High levels of estrogen• Adrenal tumors• Steroids•

True

Males don't have TDLU's•

True

Mammography can be difficult in patients who have inflammatory conditions or trauma to the breast•

True

Mammography can detect microcalcifications which may be the first sign of malignancy•

True

Mammography cannot determine whether a mass is cystic or solid•

True

Mammography is the gold standard•

True

Most ultrasounds are targeted and are limited to the quadrant of clinical concern

True

annotation• Radial (RAD) or antiradial (AR)• Clock face position• Distance from the nipple• Breast divided into 3 equal sections• 1=inner third• 2=mid third• 3=outer third• Depth• Distance from the skin to the chest wall divided into 3 equal sections• A=anterior third• B= mid third• C=posterior third

True

The majority of the glandular tissue of the breast is found in the _________________

Upper Outer Quadrant•

While Sag and transverse planes can be used, radial and ______________ scan planes are of value• Due to the arrangement of the lactiferous ducts• Transport milk to the nipple

antiradial

Positioning• You may need to roll the patient slightly to 'spread' the breast evenly• Elevate the side being scanned with a wedge under the shoulder• 30-45 degrees• Raise the _________________ arm over the patient's head

ipsilateral

Anatomy• The primary function of these modified sweat glands(breast)

is to produce milk to nourish maternal offspring•

Puerperal mastitis is inflammation due to ____________________

lactation•

Gynecomastia• clinically present with a tender palpable retroareolar breast mass• Sonographically appears as a ______________ _______________ mass posterior to the areola

triangular hypoechoic