Call back from screening mammogram for multiple focal asymmetric density in the right breast. DIAGNOSTIC MAMMOGRAM OF THE RIGHT BREAST: Three standard views with spot compression of right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution.The previously described 3 focal asymmetries seen in the upper outer right breast persist on the spot compression. In addition, another small asymmetry in the right middle breast is also confirmed on the CC view with spot compression. Incidental note is made of the low-lying right axillary lymph node.TARGETED ULTRASOUND OF THE RIGHT BREAST:On physical examination, no mass is appreciated in the upper-outer right breast and medial right breast. At the 9:00 location of the right breast, approximately 5 cm from the nipple, 2 adjacent oval, well-circumscribed hypoechoic masses are identified measuring up to 4 mm in maximum diameter. These two masses demonstrate fatty hila and central vascular flow, most compatible with intramammary lymph nodes and corresponding to the 2 adjacent well defined masses in the mid right breast upper outer quadrant on the diagnostic mammogram.There is no sonographic finding to correlate mammographic area of concern in the upper outer right breast, slightly posterior to the above intramammary lymph nodes.At 4:00 location of right breast, approximately 3 cm from the nipple, a 5 x 2 x 5 mm well-circumscribed hypoechoic mass is noted, which is parallel to the skin, most compatible with a small fibroadenoma.Incidental note is made of the 7 x 8 mm right axillary lymph node, corresponding to the mammographically incidental finding.
A small focal asymmetry in the upper outer posterior right breast without sonographic correlate or abnormal finding on physical exam, probably a benign process. Other benign findings as described above. As long as the patient's physical examination remains unremarkable, right unilateral diagnostic mammogram is recommended in 6 months. Results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).