ARRS 2022 Abstracts

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E1677. On-Call Encounters with Breast Imaging: More Than Meets the Eye
Authors
  1. Henal Motiwala; University of Maryland Medical Center
  2. Mariam Viquar; University of Maryland Medical Center
  3. Nikki Tirada; University of Maryland Medical Center
Background
Breast-related emergencies can range from a wide variety of causes and include mastitis with secondary abscess formation, implant rupture, and trauma. Breast lesions are also incidentally discovered on cross-sectional imaging. Breast malignancies tends to arise insidiously such as inflammatory breast cancer, which can mimic cellulitis. Radiologists who are not fellowship-trained in breast imaging or residents who may have limited exposure to breast imaging prior to taking overnight call may be uncomfortable interpreting these findings and correlating them to recent mammograms or know when to recommend breast surgical consultation. Another point to consider when interpreting these cases is if a dedicated breast sonographer performed the examination, which is uncommon in an urgent care or emergency room setting. Appropriate imaging technique and follow-up is crucial in management of these patients as breast malignancies can masquerade as abscesses on ultrasound, and if faced with a breast lesion on CT, for example, breast tissue differentiation is suboptimal. Familiarity with the different types of breast pathologies and their radiographic findings will not only expedite diagnosis but also improve patient outcomes.

Educational Goals / Teaching Points
The teaching points will be to identify normal breast anatomy through multiple imaging techniques including mammography, US, CT, and MRI. Concurrently, the radiographic findings of an array of breast pathologies such as abscess, implant rupture, and hematoma, and incidental findings on imaging will be shown. Imaging interpretation pitfalls, missed opportunity for early cancer detection, and missed diagnoses will also be reviewed. Additionally, benign findings that do not require further work up such as post-surgical changes, fat necrosis, and expected physiologic changes related to pregnancy and breastfeeding will also be touched upon. There will be discussion about the differential diagnoses to consider for each case, recognizing their imaging characteristics for a timely diagnosis, as well as appropriate management recommendations.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Key points of this exhibit include breast imaging and breast ultrasound technique as well as breast anatomy, breast trauma, breast abscess, incidental findings in the breast.

Conclusion
Breast-related emergencies and incidental findings are common and can be undoubtedly misdiagnosed, especially in the “on-call” setting with non-breast specialized technicians and radiology residents/attendings. With the obscurity associated with breast complications in a physical exam, radiologists face an inevitable task in evaluating and diagnosing subtle characteristics of breast-related pathology that can range from benign to malignant. This exhibit provides educational information with accompanying radiological and clinical images of characteristic features of several breast-related emergencies as well as incidental breast findings for which appropriate follow-up will be discussed.