1. Oral Boards
Simplified

2. How to take a case

3. Systematic approach to
every breast case
Breast density
Finding
BIRADS (0 or 2)
----------------------------------------------
Workup
Specific findings
Final Impression and BIRADS (2 or 4)

4. Systematic approach to
every breast case
Breast density
Fatty
Scattered
Hetereogenously dense
Extremely dense

5. Systematic approach to
every breast case
Breast density
Finding
Mass
Asymmetry / Focal asymmetry
Calcifications
Architectural distortion

6. Systematic approach to
every breast case
Breast density
Finding
BIRADS (0 or 2)
---------------------------------------------------------

7. Systematic approach to
every breast case
Breast density
Finding
BIRADS (0 or 2)
----------------------------------------------
Workup
Additional views / modalities

8. Systematic approach to
every breast case
Breast density
Finding
BIRADS (0 or 2)
----------------------------------------------
Workup
Specific findings

9. Systematic approach to
every breast case
Breast density
Finding
BIRADS (0 or 2)
----------------------------------------------
Workup
Specific findings
Final Impression and BIRADS (2 or 4)

10. What to say

11. “The breasts are heterogenously dense”
“There is a focal asymmetry in the
superior and central right breast”
“This is a BIRADS 0, additional evaluation
is required”

12. ------------------------------------------------------------------------------------------------
“I would do a lateral view, spot
compression and an ultrasound”
“The focal asymmetry persists on the lateral and spot
views. Ultrasound demonstrates an irregular
hypoechoic mass with posterior acoustic shadowing”
“This is a suspicious mass. BIRADS 4, biopsy is
recommended.”

13. Final BIRADS at Boards
Avoid BIRADS 3
All cases will be BIRADS 2 Benign
or
BIRADS 4 Suspicious

14. 15 Must-Know Cases
Workups Aunt Minnies Special
1 1 1
2 2 2
3 3 3
4 4 4
5 5 5

15. Case 1

19. Case 1: Solid mass
1. Specific diagnosis is not important
2. How to workup the finding is the key
3. Be consistent –
Suspicious descriptors  BIRADS 4
Benign descriptors  BIRADS 2

20. Mass Workup
Lateral
Spot Mag
Ultrasound

21. Mass descriptors - Mammo
Shape (round, oval, lobular, irregular)
Margins (well-circumscribed, microlobulated,
partially obscured, indistinct, spiculated)
Density (high density, isodense, low density,
fat-containing)

22. Mass descriptors - US
Shape (oval, round, irregular)
Echogenicity (anechoic, hyperechoic, complex/mixed,
hypoechoic, isoechoic)
Margins (well-circumscribed, indistinct, angular,
microlobulated, spiculated)
Orientation (wider than tall, taller than wide)
Posterior features (shadowing, increased thru transmission, none)

23. For the boards:
We biopsy all new solid
masses

24. Case 2

27. You can use the mouse as
a magnifying glass
during the exam

29. Case 2: Suspicious calcifications

30. Calcifications
Lateral
Mags in CC / 90
(Full or spot)

31. Case 3

35. Case 3: Suspicious focal
asymmetry

36. Focal asymmetry /
Architectural distortion
Lateral
Spot Compression
+/- Ultrasound
Same workup for architectural
distortion as for focal asymmetry

37. Case 4

39. Rolled views

40. Case 4: Suspicious asymmetry
Boards cases
will not be this
subtle

41. Asymmetry
Only on CC
Rolled CC’s
Spot compression
Only on MLO
Lateral
Spot compression

42. Case 5

47. Case 5: Suspicious
palpable mass
Always look
for a BB on
the skin =
palpable

48. Palpable Workup
Put BB on skin
Lateral
Spot in tangent
Ultrasound
* Any patient < 30 years old, start with ultrasound *

49. 15 Must-Know Cases
Workups Aunt Minnies Special
Mass
Calcs
Focal asym/arch dist
Asymmetry
Palpable

50. Case 6

55. Case 6: Skin Calcifications
BIRADS 2

56. How to do a skin localization
Place alpha- Keep patient in Remove from
numeric grid compression. compression. Take
over Place BB on skin image with BB in
calcifications & directly over the tangent to prove
image. calcs & image. calcs are in the skin

57. Milk of Calcium Skin calcifications
Secretory calcifications Hyalinized fibroadenoma
Other Benign
Calcifications

58. Case 7

60. Case 7: Breast Hamartoma
BIRADS 2

61. Fat containing breast masses = BIRADS 2
Lipoma Hamartoma Oil cyst

62. Case 8

64. Case 8: Bilateral intracapsular &
left extracapsular implant rupture
Linguine or keyhole sign = Intracapsular rupture
Free silicone = Extracapsular rupture

65. Intracapsular Extracapsular

66. Intracapsular Extracapsular
Stepladder sign Snowstorm sign

67. Case 9

71. Case 9: Fat Necrosis
BIRADS 2

72. Fat Necrosis
= oil cysts or coarse dystrophic calcs

73. Case 10

75. Case 10: Sternalis muscle
BIRADS 2

76. 15 Must-Know Cases
Workups Aunt Minnies Special
Mass Benign calcs
Calcs Fat containing
Focal asym/arch dist Implant rupture
Asymmetry Sternalis
Palpable Fat necrosis

77. Case 11

79. Case 11: Complex cyst
BIRADS 4

80. Simple Complicated Complex
BIRADS 2 BIRADS 3 BIRADS 4

81. Case 12

85. Case 12: Unilateral axillary adenopathy

86. Bilateral DDx Unilateral DDx
Lymphoma
Mets – breast 1⁰
Rheumatoid/Autoimmune
Mets – non-breast 1⁰
Granulomatous/Sarcoid
Infection
Systemic processes

87. Case 13

89. Case 13: Multiple round masses
BIRADS 2

90. Multiple round masses = BIRADS 2
Must be:
Bilateral
At least 3 masses
Nonpalpable
No new or suspicious findings

91. Case 14

93. Case 14: Suspicious left breast mass w/ pec
invasion + axillary nodes

94. Mass NMLE

95. Main MRI finding will be obvious
Look for secondary findings
- multifocal disease
- contralateral disease
- axillary or IM adenopathy
- pectoralis or skin involvement

96. Mass NMLE
Shape Distribution
(round, oval, lobulated, irregular) (focal, linear, ductal, segmental,
regional, diffuse)
Margins
(smooth, irregular, spiculated) Enhancement Pattern
(homo, hetero, stippled, clumped)
Enhancement
(homo, hetero, rim, internal septations)

97. Case 15

101. Case 15: Male IDC

102. Gynecomastia Male IDC
Signs of Male IDC:
- Eccentric mass
- Skin thickening
- Skin retraction

103. 15 Must-Know Cases
Workups Aunt Minnies Special
Mass Benign calcs Cysts
Calcs Fat containing Axillary adenopathy
Focal asym/arch dist Implant rupture Mult round masses
Asymmetry Sternalis MRI
Palpable Fat necrosis Male breast

104. Your Name Here
American Board of Radiology