Ms. Thompson is a 61 year old female presenting with bilateral palpable masses, which have increased in size when compared to the prior ultrasound examination. Patient previously had a fine-needle aspiration of right breast mass with findings consistent with fat necrosis. Upon physical exam of both breasts, there are bilateral large tender palpable masses appreciated (right greater than left). These sites were identified by the patient and Dr. Chhablani.In the right breast 2:00 location, approximately 4 cm from the nipple, there continues to be vague hyperechoic areas with mildly increased vascularity. This finding appears very similar to prior ultrasound exam from April 2015.In the left breast 10:00 location, approximately 5 cm from the nipple, there are similar ultrasound findings consistent with vague hyperechoic areas with mildly increased vascularity. This finding is also very similar to prior ultrasound exam from March 2015.
Vague areas of mixed echogenicity at the areas of palpable concern in both breasts, suggestive of fat necrosis. Given that these areas have increased in size and are palpable, a palpation-guided biopsy is recommended for confirmation of findings. All results and recommendations were relayed to the patient and Dr. Chhablani at time of examination. Per discussion with Dr. Chhablani , the patient will be off of her Coumadin for 4 days prior to the biopsy.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.