Vascular Abnormalities of the Breast

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Breast Sonography: 3.25
Procedures: 3.25
Anatomy and Physiology: 1.25
Pathology: 2.00

Mammography: 3.25
Procedures: 3.25
Anatomy, Physiology, and Pathology: 3.25

Magnetic Resonance Imaging: 3.25
Procedures: 3.25
Body: 3.25

Nuclear Medicine Technology: 3.25
Procedures: 3.25
Endocrine and Oncology Procedures: 3.25

Registered Radiologist Assistant: 3.25
Procedures: 3.25
Thoracic Section: 3.25

Sonography: 3.25
Procedures: 3.25
Superficial Structures and Other Sonographic Procedures: 3.25

Radiation Therapy: 3.25
Procedures: 3.25
Treatment Sites and Tumors: 3.25

Outline

1. Introduction
2. Normal Breast Arterial, Venous, and Lymphatic Anatomy
3. Normal Imaging Appearance of Breast Vasculature
4. Arterial Disorders of the Breast
   1. Atherosclerosis
   2. True and False Breast Aneurysms
5. Venous Disorders of the Breast
   1. Collateral Venous Flow in the Breast
   2. Congestive Heart Failure
   3. Superficial Thrombophlebitis
   4. Breast Varix
6. Benign and Malignant Vascular Breast Masses
   1. Benign Vascular Breast Masses
      1. Hemangioma
      2. Lymphangioma
      3. Angiolipoma
   2. Malignant Vascular Breast Masses
      1. Angiosarcoma
      2. Hemangiopericytoma
   3. Devascularized Breast Masses
      1. Infarcted Lactating Adenoma
      2. Infarcted Giant Juvenile Fibroadenoma
   4. Pathologic Mimics of Vascular Masses
      1. Pseudoangiomatous Stromal Hyperplasia
      2. Phyllodes Tumor
7. Conclusions

Objectives

Upon completion of this course, students will:

1. identify the breast gland type
2. know the breast arterial supply
3. identify the most dominant artery supplying the breast vasculature
4. identify which arteries supply the medial and central parenchyma of the breast
5. know venous anatomy of the breast
6. be familiar with the superficial venous network in the breast
7. identify factors that influence normal increases in blood supply to the breast
8. recognize factors that can influence differentiation of veins and arteries during imaging
9. recognize spectral Doppler analysis of a normal breast artery
10. clarify how breast vessels are identified and differentiated on ultrasound
11. review how compression maneuvers on ultrasound can help identify pathologies
12. consider how resistive indices are used during breast imaging
13. understand the MIP post-processing technique
14. recognize the significance of asymmetrical breast vascularity
15. realize the need for a good understanding and assessment of normal and pathologic breast vasculature
16. describe the appearance of atherosclerotic vessels when seen on mammography
17. identify potential risk factors that should be considered when atherosclerotic calcifications are encountered
18. discuss breast aneurysms and pseudoaneurysms
19. realize the significance of bilaterally enlarged breast veins
20. know the significance of unilateral superficial breast vein dilatation
21. recognize the vascular characteristics typically seen in the breast of a patient with congestive heart failure (CHF)
22. identify the breast pathologies related to unilateral breast edema
23. discuss Mondor disease of the breast
24. explain the pitfalls of mammographic imaging of a breast varix
25. identify potential causes of bilateral breast varices
26. gain knowledge of the most common types of benign vascular tumors of the breast
27. distinguish classifications of breast hemangiomas
28. examine the reliable distinguishing features of a breast hemangioma
29. understand the most common locations in the breast where lymphangiomas typically grow
30. characterize the appearance of color flow Doppler in lymphangiomas
31. identify other breast abnormalities that breast lymphangiomas might mimic
32. identify other breast abnormalities that breast angiolipomas can mimic on ultrasound
33. define breast angiosarcomas
34. classify breast angiosarcomas
35. distinguish the most common location for development of angiosarcomas
36. know what histopathologic diagnoses can resemble a hemangiopericytoma
37. identify types of devascularized breast masses
38. explain when infarcted lactating adenomas occur
39. know the most common breast masses found in girls
40. explain pseudoangiomatous stromal hyperplasia (PASH)
41. recognize the mammographic, sonographic, and MR features of vascular breast masses
42. know what other breast abnormalities the histologic appearance of PASH can resemble
43. realize what percentage of phyllodes tumors will demonstrate regions of malignant degeneration
44. know what percentage of phyllodes tumors are true sarcomas that can metastasize hematogenously
45. distinguish what patient age group is most affected by phyllodes tumors