E5298. Beyond the Breast: Mediastinal Findings Encountered on Breast MRI
  1. Rachel Roth; Georgetown University
  2. Nancy Kim; Georgetown University
  3. Rend Al-Khalili; No Affiliation
  4. Erini Makariou; Georgetown University
  5. Janice Jeon; Georgetown University
  6. Judy Song; Georgetown University
  7. Erin Crane; Georgetown University
MRI is a highly sensitive and frequently utilized imaging modality for the evaluation of breast pathology. A significant portion of the mediastinum is included on standard breast MRI and may occasionally reveal incidental mediastinal findings. In addition to breast pathology, breast radiologists are responsible for thoroughly evaluating the mediastinal structures within the FOV. Knowledge of the mediastinal compartments and familiarity with potential mediastinal pathologies is crucial for proper patient care. Breast radiologists should be able to provide a diagnosis or recommend appropriate follow-up if an incidental mediastinal finding is encountered.

Educational Goals / Teaching Points
Our educational exhibit discusses and provides examples of typical imaging features of common mediastinal lesions as they might appear on standard breast MRI sequences. Through an algorithmic approach, we intend to assist breast radiologists in making a diagnosis based exclusively on available breast MR sequences or with providing additional imaging recommendations when a definitive diagnosis is not possible.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
MRI is most useful in differentiating cystic versus solid lesions and assessing their relationship with surrounding structures; however, due to fewer sequences, limited FOV, and prone positioning, complete evaluation of some lesions may prove difficult or even impossible without additional imaging. Some common mediastinal masses as well as additional mediastinal findings that may appear masslike on breast MRI include multinodular goiters, thymic masses, lymphadenopathy, foregut duplication cysts, pericardial cysts, aberrant vasculature, neurogenic tumors, and hiatal hernias. Breast radiologists should be familiar with the typical MR appearance of these mediastinal findings as well as the limitations of breast MRI to avoid diagnostic pitfalls.

As the utilization of breast MRI increases in clinical practice, the likelihood of encountering incidental mediastinal findings is also presumed to increase. Despite the primary goals of breast MRI, incidental mediastinal findings should not be neglected. Some mediastinal findings may be confidently diagnosed on standard breast MRI sequences while others may require additional workup. It is crucial for breast radiologists to be familiar with these findings to ensure appropriate patient care.