ฝึกพูดภาษาอังกฤษด้วยเทคนิค Shadowing จากวิดีโอ: Breast Ultrasound Normal Vs Abnormal Image Appearances Comparison | BI-RADS Classification USG

hello everyone this is dr sam and today we will study breast ultrasound image appearances here we

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hello everyone this is dr sam and today we will study breast ultrasound image appearances here we

have the images of normal breast the uppermost layer is the skin this is the hyperechoic

layer and below that is the subcutaneous zone it is usually hypoechoic as compared to the tissues

below and the largest region is the mammary zone it usually has mixed echogenicity most

of the pathologies occur in this zone and this hyperechoic area is the fibro glandular tissue

these hyperechoic slanted or diagonal lines are cooper ligaments this striated structure

is the pectoral muscle the retro memory zone lies between the pectoral muscle and the memory zone

usually it appears smaller because it is compressed due to probe pressure

and this shadowing over here is due to the rib here we have more images of normal breast

we can see the three zones and the fibro glandular tissue which is hyperechoic usually the

retro memory zone is below this fibroglandular tissue but it is not always the case

breast pathologies can be classified by using a system known as bi-rads

it stands for breast imaging reporting and data system in total it has seven categories

in bi-rads 0 we need further images we need more scans such as mammograms or ultrasound scans

bi-rads 1 is for normal breast tissue where there is no mass or no distortion

no lesion both these images are by reds one

a simple cyst will appear as an anechoic structure with posterior enhancement the cyst will be round

or ovoid with a smooth hyperechoic border it is classified as bi-rads 2 which is benign

a complicated cyst will have fat fluid levels and internal echoes

these are fat fluid levels the low density fluid is at the top and the high density fat

is at the bottom now these cysts may resemble malignant lesions that is why a follow-up is needed examples of complicated cysts include oil cysts and galactocysts

a fibroadenoma is a benign tumor which will appear as a hypoechoic round or ovoid mass

it may have a hyperechoic rim known as a pseudo capsule and it has a parallel orientation it is

wider than tall you can see it is wider instead of being taller this is a sign of benign lesion

it is classified as bi-rads 2 which is benign however routine screening mammography should be

done here we have another image of fibroadenoma it has a smooth border it may have calcifications

you can see the pseudo capsule here and it has a parallel orientation it is wider than tall

a lipoma will appear as a hyperechoic rounded mass usually hyperechoic rounded masses are benign it

has a bi-rads score of two despite this appearance routine screening mammography should be done

hyperechoic masses that are ovoid rounded or well circumscribed are usually benign another benign

feature is the parallel orientation in which it is wider than tall examples include angio lipoma

hemangioma hamartoma they usually appear as hyperechoic masses with a hyperechoic border

here we have an image of intra memory lymph node they have a hypoechoic outer cortex

this is the cortex and a hyperechoic central mediastinum

which is hyperechoic usually due to fat they are classified as bi-rads 2

a neurofibroma is a rare benign tumor

which appears as a hypoechoic mass with posterior enhancement now it is very tricky because it resembles a cyst so it can be misdiagnosed very easily but it is a rare lesion

a sebaceous cyst is a complex cyst which is present closer to the skin

here you can see it is present just below the skin and it is even involving the skin so this superficial location can help us in diagnosing sebaceous cyst it is classified as bi-rads 2

a simple cyst containing a small hyperechoic calculus

is usually a milk of calcium cyst these cysts are also benign

egg shell calcifications are small calcifications which may have shadowing if they are a bit dense

they have a bi-rads score of two complex cysts are rated as bi-rads 3 because they need a follow-up exam usually thin hyperechoic septations

are benign but they still need a follow-up so that is why it is rated as bi-rads 3

clustered microcysts will have a group of cysts clustered together the diameter is less than three millimeters and septations may be present it is rated as bi-rads 3 because follow-up is required

fat necrosis has a variety of appearances in the acute phase the lesion is new so it may appear as a hyperechoic lesion due to edema fat necrosis

appearances overlap with malignant lesions so a follow-up is required so it is rated as bi-rads 3

fat necrosis enters late stage after 1.5 years

it will have calcified walls which give posterior acoustic shadowing

now we move on to bi-rads categories which have chance of malignancy bi-rads 4 has 3 sub-categories

in 4a the chance of malignancy is between 2 to 10 percent b is 10 to 49 and 4c is 50 to 94 percent

bi-rads 5 has greater than 95 percent chance of malignancy

and bi-rads 6 is a biopsy proven malignancy usually hypoechoic masses with irregular walls or a speculated appearance are malignant and they have a taller than wide orientation

here we have a case of lymph node metastasis

we are comparing it with a non-malignant lymph node the cortex is very thick

which gives it an abnormally hyperechoic appearance it is usually a sign of malignancy

intraductal papilloma is not very common its appearance usually involves dilated ducts

and a well-defined nodule it is rated as bi-rads 4 and biopsy is advised

intracystic papillary carcinoma consists of a complex cyst with a thick mural based nodule

this nodule will be attached to the wall it will not move around

here we have another image of intra-cystic papillary carcinoma this one has a thick isoechoic septation as well these thick isoechoic septations are usually a sign of malignancy as opposed to the

thin hyperechoic septation which is usually benign and here is a large thick mural nodule

ductal carcinoma in situ will have hypoechoic masses which will be micro lobulated which means they have these type of outpouchings and there is no enhancement which means it is a solid mass

in this image the mass involves the ducts so it appears elongated

usually these hypoechoic masses involving the duct are ductal carcinoma in situ

invasive ductal carcinoma is the most common form of breast cancer it also has variable appearances

one of them is a circumscribed mass

hypoechoic mass with some calcifications which are usually invasive ductal carcinoma

here we have another case of invasive ductal carcinoma

we have an ill-defined hypoechoic mass and it has a non-parallel orientation it is taller than wide

the ap diameter will be more than the horizontal measurement it also has posterior shadowing which is usually a sign of grade 1 invasive ductal carcinoma but it is not always the case

here we have invasive ductal carcinoma with posterior acoustic enhancement

this enhancement is usually a sign of a higher grade cancer

it also has a speculated appearance suggesting a malignant lesion it is rated as bi-rads 4c

here we have another image of invasive ductal carcinoma

showing us a circumscribed hyperechoic mass with uniform internal echoes

it also has posterior enhancement suggesting a high grade cancer you can see that invasive ductal carcinoma has lots of appearances ultimately it is confirmed with biopsy

mastitis is the inflammation of breast tissue its appearances consists of hyperechoic fat lobules

and some hypoechoic areas another distinguishing feature is that it has thickened skin here you can see the skin is very thick as compared to the normal image these are the features of mastitis

duct ectasia involves dilated duct with branching tubular anechoic structures

with the diameter measuring more than two millimeters

the normal ducts are somewhat difficult to visualize they usually have mixed echoes

here we have a case of infected and inflamed cyst has thick isoechoic walls

and it has dependent debris which means this debris will settle down due to gravity

this is the gravity dependent side this debris will move in accordance with the patient position

this debris will move using this feature we can differentiate it from a neural nodule

another feature is seen on doppler it is the presence of increased blood flow in the thick wall

a normal breast implant is anechoic with a double layered hyperechoic shell

and these are the normal breast tissues in an implant rupture we have a step ladder sign

which are linear horizontal hyperechoic bands representing force of a collapsed shell

it suggests intracapsular rupture

a silicone granuloma suggests extra capsular rupture and gives us a snowstorm sign in this we have a hyperechoic circumscribed superficial border

with dirty posterior shadowing this shadowing is grayish

thank you so much for watching please subscribe and stay tuned for more imaging videos

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