{"id":266,"date":"2025-06-03T22:50:16","date_gmt":"2025-06-03T22:50:16","guid":{"rendered":"https:\/\/depts.washington.edu\/breast-imaging-teach\/?p=266"},"modified":"2025-06-30T10:23:39","modified_gmt":"2025-06-30T18:23:39","slug":"case-18","status":"publish","type":"post","link":"https:\/\/depts.washington.edu\/breast-imaging-teach\/?p=266","title":{"rendered":"Case 16"},"content":{"rendered":"

Contributed by: Steven J. Rockoff, MD and Diana L. Lam, MD – June 1, 2020<\/p>\n

\n

Question 1<\/h3>\n
\n

A 58-year-old man presents with a palpable lump in his right breast.
What is the most appropriate imaging test to perform first?<\/em>
A. Diagnostic ultrasound
B. Diagnostic mammogram
C. Screening mammogram<\/p>\n

\n

Answer<\/h4>\n
\n

B. Diagnostic mammogram<\/strong><\/p>\n

Explanation: <\/strong>According to the American College of Radiology Appropriateness Criteria, for a male who is 25 years or older, the most appropriate imaging exam to perform first with a clinically indeterminate palpable breast mass is a diagnostic mammogram.<\/p>\n

This patient has focal symptoms, so a screening exam is not appropriate. There are also currently no indications to screen males for breast cancer.<\/p>\n

A bilateral diagnostic mammogram was performed. Images of the right breast shown here do not demonstrate any mammographic abnormality under the BB skin marker:<\/p>\n

\"\"<\/figure>\n
\"\"<\/figure>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
\n

Question 2<\/h3>\n
\n
\"\"<\/figure>\n

\"\"
With the mammogram appearing negative, a diagnostic ultrasound was performed. What is the diagnosis?<\/em>
A. Cyst; BI-RADS 2 (Benign)
B. Invasive ductal carcinoma; BI-RADS 4 (Suspicious)
C. Abscess; BI-RADS 2 (Benign)
D. Lipoma; BI-RADS 2 (Benign)<\/p>\n

\n

Answer<\/h4>\n
\n

Explanation: <\/strong>This is a circumscribed, oval, hyperechoic mass, which is consistent with a lipoma. They have the same imaging appearance in males and females. They may appear as circumscribed fat-containing masses on the mammogram, particularly if the patient has a lot of fibroglandular tissue. Since this male\u2019s breast is composed predominantly of fat density, the lipoma cannot be easily discerned on the mammogram. On ultrasound, a lipoma (arrows) is either isoechoic or slightly hyperechoic to the surrounding subcutaneous fat (*). Lipomas are benign and when correctly identified on imaging, they do not require further follow-up.<\/p>\n

D. Lipoma; BI-RADS 2 (Benign)<\/strong><\/p>\n

\"\"<\/figure>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Contributed by: Steven J. Rockoff, MD and Diana L. Lam, MD – June 1, 2020<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[],"class_list":["post-266","post","type-post","status-publish","format-standard","hentry","category-quiz"],"_links":{"self":[{"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/posts\/266","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=266"}],"version-history":[{"count":7,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/posts\/266\/revisions"}],"predecessor-version":[{"id":690,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=\/wp\/v2\/posts\/266\/revisions\/690"}],"wp:attachment":[{"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=266"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=266"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/depts.washington.edu\/breast-imaging-teach\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=266"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}