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84 Cards in this Set
- Front
- Back
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Are most calcifications benign or malignant
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benign
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What are the 2 most important characteristics to determine when analying breast calcificiations
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morphology and distribution
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What is the ddx of a typical benign calcification (birads 2)
7 |
calcifications with radiolucent center
milk of calcification vascular calcification popcorn calcifications large rod like calcification round calcification FB injection granuloma |
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What is large rod like calcification associated with
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duct ectasia
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What are some types of calcifications that may have a radiolucent center
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lucent centered calcification
egg sheel or rim calcification skin calcification (sometimes) dystrophic calcification (sometimes) |
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What are the characteristics of 'lucent centered calcifications'
5 |
variable size
round or oval smooth surfaces lucent centers (obviously) walls are thicker than eggshell/rim type |
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What are lucent centered calcifications associated with
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fat necrosis or calcified debris in ducts or oil cyst
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What are the characteristics of eggshell/rim calcifications
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smaller than 1mm in thickness
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What are eggshell/rim calcifications associated with
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fat necrosis and oil cyst (like calcificaton with lucent center)
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What does a rim calcification/egg shell represent
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calcification deposit on the surface of a sphere
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can an oil cyst be either 'lucent centered calcificaton or an eggshell/rim calcification
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yes (depends on the thickness of surrounding calcs)
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Where is the MC location of skin calcifications
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inframammary fold, parasternal axilla, and areola
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How do you diagnose skin calcifications
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tangental view
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Do skin calcifications typically have a radiolucent center
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yes
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When are dystrophic calcifications typically seen
2 |
irradiated breast
s/p trauma |
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What are the mamographic charateristics of dystrophic calcifications
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irregular
larger than 0.5mm often have lucent centers |
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If fat necrosis calcifies what does it look like
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rim calcifications and with time will become thicker an more like
dystrophic calcifications |
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What is the birads category of fat necrosis or oil cyst
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Birads 2
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What type of calcifications is sometimes assoicated with biopsy
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dystrophic calcifications in the plane of biopsy
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What do you do if you are unsure if calcifications are benign or malignant
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birads 3 and fu in 6 months
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Calcifications with radiolucent center
4 |
lucent centered calcifications
egg shell or rim skin calcifications (sometimes) dystrophic calcificatons (sometimes) |
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What is milk of calcium calcificationss
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sedimetnted calcifications in macro or microcyst
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What is the appearance of MOC calcifcations on the lateral view
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more clearly defined
semilunar crescent shaped curvilinear or linear |
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What is the appearance of MOC calcifications on CC view
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less evident and appears fuzzy
round amorphous deposits |
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What is the most important characteristic of MOC calcifications
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change in shape of calcifications on different views
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What are the typically benign calcifications covered so far
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calcifications with radiolucent centers (and subtypes)
MOC calcifications (now vascular calcifications) |
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Describe vascular calcifications
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parallel tracks
linear callcifications associated with tubular structure |
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When do you want to report vascular calcifications
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women less than 50 (increased risk of CAD)
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What are the typically benign calcification covered so far
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calcifications with radiolucent centers (and subtypes)
MOC calcifications vascular calcifications (now coarse or popcorn calcifications) |
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Describe popcorn like calcifications
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classicaly large greater than 2-3mm in diameter
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What is the MCC of popcorn like calcifications
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involuting fibroadenomas
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What is typical location of the calcification of an involuting fibroadenoma
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eccentric
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What is the ddx for a heavily calcified mass
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involuting fibroadenoma
cacified hematoma fat necrosis |
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What is the work up for a heavily calcified mass
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it is benign and no further work up required
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If there is a mass that has faint calcifications that are more central in location what is the work up
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biopsy
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What are large rod-like calcifications associated with
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duct ectasia
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What are the characteristics of large rod like calcifications
3 |
solid or smooth linear rods
radiate towards the nipple occasionally branch |
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Can large rod like calcifications (ductal ectasia) have lucent centers when calcium forms in the duct walls
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yes
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Is ductal ectasia usually bilateral
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yes
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When is ductal ectasia typically seen
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women older than 60y
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What are the two types of ductal ectasia
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intraductal
periductal (lucent centers?) |
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What is more common intraductal or periductal ectasia
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intraductal
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If there is rod like calcifications in one breast do you continue a work up
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yes
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IS round calcifications another type of benign calcificaitons
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yes
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Describe findings of benign round calcifications
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variable size (small and punctate)
scattered |
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If round calcifications are clustered what should be done
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close surveillance or biopsy (especially if new or ipsilateral to cancer)
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What are the typically benign calcifications we have covered
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calcifications with a lucent center (and sub categories)
MOC calcifications Vascular calcifications Coarse/Popcorn large rod like (duct ectasia) round calcification (now FB injection granuloma) |
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What are some causes of FB injection granuloma
2 |
silcone
parafin |
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Are FB injections granulomas bilateral
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yes (inject both breast btw this is uncommon bc illegal in US)
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What category are typically benign calcifications
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birads 2
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What are the intermediate concern (suspicious calcifications) birads 4
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amorphous or indistint calcifications
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Describe the characteristics of Amorphous or indistinct calcifications (this is intermediate or suspicous calcifications)
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small hazy in appearance that is difficult to discern
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Can diffuse scattered amorphous calcifications usually be dismissed as benign
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yes (with the help of mag views)
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If there is clustered, regional, linear or segmental distribution of amorphous calcifications should you biopsy
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yes
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Beside amorphous calcifications what is another intermediate concern/suspicous calcification
(birads 4) |
coarse heterogenous
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Describe coarse heterogenous calcifications
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irregular, conspicuous calcifications that are generaly larger than 0.5 mm and tend to coalesce but are not the size of irregular dystrophic calcifications
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What is the size of a coarse heterogenous calcification
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generally greater than 0.5mm
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What are coarse heterogenous calcifications associated with
4 |
malignancy
fibrosis fibroadenomas post trauma |
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How is heterogenous calcification differentiated from coarse dystrophic calcifications
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tend to coalesce
smaller |
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What are the 2 birads 4 category calcifications
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amorphous
coarse heterogenous |
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What category are fine pleomorphic calcifications
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category 5
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Describe the findings of fine pleomorphic calcifications
(correct prior slide these are birads 4-5) |
variable size and shape
less than 0.5cm in diameter |
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What are the 2 high probabitly calcifications patterns for malignancy
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Fine pleomorphic
Fine linear or fine branching calcifications |
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Describe fine linear/branching calcifications
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thin, linear or curvlinear irregular calcifications which may be discontinous and are smaller than 0.5mm width
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What does the finding of fine linear/branching calcifications suggest
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filling of lumen or duct involved with cancer
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What are fine pleomorphic and fine linear/branching calcs birad category
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4 or 5
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What is the calcifications of a fibroadenoma
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popcorn (birads 2)
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Are coarse heterogenous calcifications suspicious
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yes birads 4
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What is diffuse or scattered calcification
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randomly throughout the breast
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If there is punctate and amorphous calcifications though out the breast what is the birads category
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B2 (likely benign)
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What is the definition of regional calcifications
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scattered in a large volume (>2cc) of breast tissue not conformed to a duct distribution
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What is the definition of grouped or clustered calcificatios
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at least 5 calcifications occupying a small volume (less than 1 cc) of tissue
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What is linear distribution of calcifications
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calcifications that are arrayed in a line (this may raise suspicioun as it suggest ductal distribution)
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What should linear distribution be differentiated from
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vasclular calcs
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Do linear calcifications warrant biopsy
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yes
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What do you do if you have a round (non-suspicious) morphology and a supsicious (linear) distribution
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go with the higher suspicious feature and biopsy
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What is segmental distribution
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calcifications in a lobe or segment of breast
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Is segmental distribution worrisome
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yes suggest deposits in ducts and their branches
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Are both linear and segmental distribution of calcifications worrisome
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yes
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What Birads category is probably benign
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birads 3
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What type of calcifications go in the birads 3 category
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round or punctate
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What is the classifications of round or punctate calcifications in a linear or segmental distribution
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birads 4 (bc of suspicous distribution)
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If you have round or punctate calcifications what should be done
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further work up with mag views
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can round and clustered calcifications undergo survailence
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yes ??
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