There are many reasons a breast ultrasound can be difficult. You may be dealing with a true mass, a non-mass lesion, a region of inflammation or an area of normal tissue for that patient. The Sonographer needs strategies to decide if we are likely to be dealing with a benign or malignant region. This presentation will give the Sonographer strategies to notice and work up areas within the difficult breast, which may or may not have pathology.
The pathology may be difficult to see or camouflage because:
1. It is isoechoic to the surrounding tissue.
2. It lies amongst shadowing Cooper’s ligaments.
3. It is within dense breast tissue-not enough penetration.
4. More compression is needed.
5. Less compression is needed- with low flow settings.
6. It is larger than probe size.
7. Invasive cancer-non defined edges.
8. There is no solitary mass and the anatomical variation has not been recognised.

The presentation will show many cases with pathology initially not recognised unless “worked up”. The demonstration will cover the importance of ultrasound anatomical recognition, technical strategies including probe technique, breast positioning and machine optimization. Techniques will include strategies to visualise ductal lesions behind the nipple and recurrence adjacent scars. Dynamic options to recognise surrounding tissue effects will also be given.