Palpable left breast mass and axillary region presents for left breast ultrasound.Patient weighs over 400 pounds and cannot stand. Mammography cannot be performed. Patient's inpatient bed cannot be revealed into the mammography suite, therefore ultrasound was performed in Mitchell ultrasound suite A targeted left breast and axillary ultrasound was performed for the palpable area of concern. On physical examination, inverted left nipple noted with skin changes and puckering. At least 4 cm palpable mass noted in the left nipple 10 to 12:00 position and left axillary region.Multiple irregular hypoechoic masses are identified in the left retroareolar region, largest measuring 4.8 x 3 cm. The masses are inseparable from the nipple. Skin thickening noted. Superior breast demonstrates skin thickening with mild edema.At least 4 abnormal enlarged axillary lymph nodes identified, largest measuring 5.3 x 6.3 cm.
Limited examination, ultrasound performed in Mitchell ultrasound suite. Mammography cannot be performed as patient weighs 400 pounds and is immobile.Multifocal masses in the left retroareolar region with skin thickening and nipple retraction, inseparable from the nipple highly suspicious for malignancy.At least 4 abnormal enlarged left axillary lymph nodes noted. Given these findings, and rheumatoid breast cancer cannot be ruled out.Findings and recommendations were discussed with Joly Jose.FNA based on palpability is recommended.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: B - Surgical Consultation.