Copyright © 1997-2001 Mammography Specialists Medical Group Inc. All rights reserved

HISTORY:
70 year old for screening.

DIAGNOSIS:
Craniocaudal positioning. Fibroadenoma.

FINDINGS:
First right craniocaudal view appears well positioned
on initial glance but note that it has slight lateral
exaggeration. The nipple-pectoral line measurement
(NPL) is 7.8 cm on this film.


Image 1. R CC (first)

The second craniocaudal view is better positioned and
has an NPL of 8.7 cm. This 0.9 cm difference was
radiographically important in this case. Note the second
CC includes a calcified nodule in the medial breast.


Image 2. R CC (second)

This lesion is confirmed with a cleavage (CV)
craniocaudal view which shows portions of both the right
and left medial breasts.


Image 3. CV (Cleavage view)

The right lateral view also shows this partially
calcified fibroadenoma near the pectoralis muscle
posteriorly.


Image 4. R LAT

DISCUSSION:
The nipple-pectoral line measurement is almost the same
on the right lateral view and the second craniocaudal view.
It is a centimeter shorter on the first CC view. This
measurement is the only clue that one might be missing
posterior breast tissue on the CC view and might also be
missing a significant posteriorly located lesion. In this
case the calcified nodule was a benign involuting
fibroadenoma but might have been a carcinoma. Always
look carefully at the medial breast tissue and frequently
compare the NPL measurement of the craniocaudal and oblique
views. A difference of one cm or more may indicate the need
for a repeat or additional view.

Submitted by:
Ralph L. Smathers, M.D.
Mammography Specialists Medical Group
Los Gatos, California

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