Computed tomography as an adjunct to mammography
George Crile, M.D.
Clinical Emeritus Consultant
Sebastian A. Cook, M.D.
Division of Radiology
Caldwell B. Esselstyn, M.D.
Department of General Surgery
Occasionally a mass in the breast that is clearly visible on the lateral view of a xeroradiogram of the breast is so close to the chest wall that it cannot be palpated and neither can it be seen on the superior-inferior view. Although the surgeon knows where the lesion is in the vertical axis, he has no way of knowing whether it is in the medial, lateral, or central part of the breast. In this situation it is difficult to locate and remove the tumor without extensive dissection, often causing deformity of the breast. In a recent case this problem arose and was solved by computed tomography (CT) which clearly showed the 8 mm carcinoma to be located just medially to the midline and enabled it to be excised widely with little deformity of the breast.Case report
A 53-year-old nurse, married to a surgeon, complained of discomfort and tenderness in the axillary tail of the left breast. The breasts were ample and no mass could be felt in either. Xeroradiogram showed no abnormality of the left breast, but in the upper quadrant of the right breast there was a circumscribed, slightly irregular mass 1.2 × 1.0 cm in diameter visible only on the lateral view (Fig. 1). A second attempt was made to visualize the mass on the superior-inferior view and there was a suggestion of a shadow just medial to the mid-line, but it was not definite enough to be sure (Fig. 2). The patient was placed in