Suspicious breast pseudocalcifications: BMJ case report
This case highlights the importance of obtaining high-quality mammographic images for accurate diagnosis as mammographic artefacts may obscure the true abnormalities or create pseudolesions.

This a follow-up case of an invasive right ductal breast carcinoma in a 72-year-old woman. A follow-up mammography study performed 1 year after right lumpectomy (wide local excision) showed postsurgical changes in the right breast and reveals ‘de novo’ coarse/amorphous microcalcifications in the left breast axis.

Some of these calcifications showed radiolucent centre, and can only be depicted in the craniocaudal mammographic images, raising concern for hypothetic cutaneous location, although presenting suspicious features.

Cancer biomarkers and clinical status were unremarkable.
An ultrasound (US) evaluation was further advised. The patient was told not to apply any cream, lotion or deodorant on the day of the US study. Two weeks later, the patient was referred for the US examination. The evaluation was unremarkable.

The patient reveals the previous use of a zinc-based ointment on the breast sulcus, which she applied on the day of the first mammographic study. Ointment, deodorant and talcum may contain radiopaque components such as zinc, aluminium and magnesium, which may simulate calcifications at mammography.

On the same day, a mammography study was repeated revealing total absence of the calcifications previously seen.

Learning points:-
• Ointment, deodorant and talcum may contain radiopaque components such as zinc, aluminium and magnesium, which may simulate calcifications at mammography.

• To prevent these artefacts, technologists should inform the patients, in advance, not to wear powder, deodorant and body cream or ointment prior to the mammographic examination.

• Mammographic artefacts may obscure the true abnormalities or create pseudolesions.

Read in detail here: http://casereports.bmj.com/content/2018/bcr-2018-226536.full
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