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The purpose of this study was to assess the MR imaging appearance of palpable fatty masses and to propose terminology for palpable subcutaneous fatty masses that are nonencapsulated on MR imaging.We searched the past 7 years of our institution's radiology database for reports of MR images containing the word "lipoma." Medical records were reviewed to identify patients with palpable masses corresponding to fat. Two radiologists retrospectively reviewed the MR images for the presence of an encapsulated or nonencapsulated fatty mass in the region of the palpable abnormality. Pathologic specimens, when available, were also reviewed.Between 1995 and 2001, 184 palpable subcutaneous fatty masses were evaluated on MR imaging. Of these, 46% (85/184) were encapsulated lipomas and 54% (99/184) were nonencapsulated fatty masses on MR imaging. Four masses (three encapsulated and one nonencapsulated) were surgically resected and had pathology consistent with lipomas.Many palpable fatty masses do not have definable capsules on MR imaging. We propose that a palpable mass that corresponds to a nonencapsulated prominence of subcutaneous fat on MR imaging should be reported as a nonencapsulated lipoma. More definitive reporting of this relatively common lesion will assure the referring clinician of the benign nature.

Needle core biopsy and fine-needle aspiration cytology (FNAC) provide histologic diagnoses in a wide variety of clinical settings. In breast disease, surgeons have used these techniques to evaluate palpable masses for many years. In recent years, radiologists have used image-guided adaptations of these two techniques to evaluate mammographically detected lesions.

The purpose of this study was to describe and illustrate the sonographic appearances of 19 ruptured silicone gel breast implants.We retrospectively reviewed the sonograms of 16 patients with 19 ruptured silicone gel implants from two institutions. The ruptured implant was confirmed at surgery in 17 cases and by mammographic and clinical findings of a ruptured implant combined with biopsy findings of a silicone granuloma in two cases. Breast sonograms were available for review in all patients. The clinical presentation of each patient was recorded. The sonograms and mammograms were reviewed, and the findings were correlated with the surgical findings. In 16 of the 19 ruptured implants, mammographic findings suggested rupture, including lobulation of the contour of the implant and/or silicone extrusion into the breast parenchyma or axilla. In two ruptured implants, mammographic findings were normal, and in one case, no mammogram was available. In those three patients, palpable masses and clinical findings were suggestive of rupture.Sonography showed a unique echogenic appearance called echo-dense noise, in 17 of the 19 ruptured implants; in 10 of the 17, sonograms showed hypoechoic masses of extruded silicone also. In two ruptured implants, sonograms showed only the hypoechoic masses of extruded silicone gel.Our experience suggests that echogenic noise is a unique sonographic sign of ruptured silicone gel breast implants and may be caused by phase aberration related to the speed of sound being slower in silicone than in soft tissue.

Sonography, disappointing as a primary screening method, has emerged as the single most helpful adjunct to mammography in evaluation of the clinically and/or mammographically abnormal breast. Sonography can reliably diagnose simple cysts presenting as palpable masses or as indeterminate, nonpalpable lesions on mammography. However, differentiation of benign from malignant solid masses cannot be reliably accomplished by sonography. The expense of an automated breast sonographic scanner has deterred many radiologists from the purchase of such a unit. The authors have used both an automated breast scanner and a real-time 10-MHz hand-held unit. This paper describes their experience with the real-time unit, demonstrating both normal and pathologic anatomy. Special emphasis has been placed on the sonographic diagnosis of a simple cyst because this lesion was the cause of one-quarter of all palpable masses and nonpalpable, mammographically dominant masses. Cysts are sharply marginated and anechoic. Posterior enhancement visible in 78 of 80 cysts was not demonstrable on all images in 25% of cysts.

An 8-year review done of mammography at one institution identified 30 patients who had undergone a previous breast augmentation procedure. Of the 30, six had had silicone injections, 20 silicone-filled implants, and six saline-filled implants. Both free and encapsulated silicone significantly obscured underlying breast tissue because of density and associated calcifications, which would have interfered with detection of subclinical carcinomas. Xeromammography proved useful, however, in clarifying the nature of clinically palpable masses and in studying complications following the breast augmentation procedure.