Monthly Image: Male Mammogram

This is not the Monthly Image I had scheduled for today…

A few weeks ago I reported to my doctor that I had a pressure-sensitive lump in my right breast. This happened the very next day:

Left-right Mammogram
Left-right Mammogram

It’s a composite of two mammogram images, of my left and right breasts, respectively, with the small white dots marking the obvious targets and the ring above the right dot surrounding a mole. You will be unsurprised to know that the radio-opaque markers came on cheery flowered stickers:

Radio-opaque targets
Radio-opaque targets

According to the American Cancer Society, about 2400 men will receive a diagnosis of breast cancer in 2014 and 430 men will die; those guys vanish in the roundoff of women’s breast cancer.

Given such small numbers, what you see up there on the right is almost certainly an unusually tender and mostly unilateral case of gynecomastia, which was the diagnosis relayed from the radiologist after the imaging. Because things are different for guys, there’s an appointment with an oncologist (yes, she specializes in breast cancer) and, perhaps, some biopsy samples in my immediate future.

They triage the appointment schedule based on radiographic evidence. Fortunately, I’m not on the hot list.

Potential oversharing ahead …

Some browsing with the obvious keywords shows that side effects of the blood pressure dope I was taking last year probably triggered my symptoms, with calcium channel blockers and spironolactone the most directly implicated drugs. It turns out that my blood pressure seems OK without drugs (now that they moved the goal posts for my age bracket, anyway), but we devoted half a year to discovering that nothing produced much of a direct effect and the side effects were completely unacceptable.

Protip: it’s probably not worth reducing a male’s androgen levels just to see if his blood pressure goes down. [sigh]

Back to the usual tech stuff …

Returning home with a CD of digital images in hand, I found that, unlike those older X-ray images, feeding these DICOM images (all sporting informative names like IN000001) into the current version of Imagemagick‘s convert triggers a segfault. Rummaging in the repositories produced a dedicated conversion program:

medcon -f IN* -c png

… which grinds away on the DICOM files and spits out PNG image files with the same names prefixed with an ascending sequence number of the form m000-. A burst of Perl regex line noise removes the prefixes:

rename 's/m[\d]{3}-//' *png

Figuring that out neatly diverted my mind from the Main Topic for a while…

Let this be an example to him who would be admonished: ask the Lady of your life for a preliminary checkup. She’ll know how to recognize what you didn’t think to check.

[Update:

The oncologist says I have a classic, textbook case of gynecomastia; if her med students weren’t on break, she’d use me as an example.

About 10% of males taking spironolactone for blood pressure control develop gynecomastia, typically in only one breast. Absent any other signs, there’s no need for biopsy samples or surgical intervention. The symptoms generally resolve within a year after discontinuing spironolactone.

Should the symptoms persist and become objectionable, treatments include surgery or tamoxifen… but I’m not down with that.]

15 thoughts on “Monthly Image: Male Mammogram

  1. I ran into the same problem around 2000. If I understand correctly, the ACE inhibitor class of BP meds doesn’t cause any similar problems–at least I haven’t had any problems since going to one. At least one can easily research the issues now–not much medical web content in the then. Nice that you can get the images. Most of my pictures were on film, and silver recycling was important…

    1. easily research the issues now

      And, if you’ve been around long enough, you can detect pure hokum when you see it. That certainly described one of the academic papers I read, anyway. [grin]

  2. A friend of mine gave up about half way from his around the world bike ride (from about as far north in Alaska as you can fly to, well, Antarctica, which his partner made it to). He went in for a checkup and found he had high blood pressure. The Doctor asked “Have you tried diet and exercise?” Flabbergasted, he suspected the Dr. wasn’t paying attention when he was telling his story about being a Vegetarian and recently returning from an 8k mile bike ride…

    1. Aitch observes that most of his friends with good BMI / exercise / diet also have high blood pressure: there’s a lot of that going around. Of course, we’re all Olde Fartes…

  3. I can’t help wonderinig how related spironolactone and polycaprolactone (used for 3D printing) are. I’m guessing they just both happen to have a lactic acid group somewhere in the molecule. The last time I asked my doctor for copies of my radiography (after the radiology people said they wouldn’t release them to me) to post on my blog, he grinned and said “You know, there are some people that would consider this pornography!” As for DICOM data, I used (free, open source) Osirix to view it, which, when my doctor saw it, pointed out “that’s considerably better than the horribly expensive software they made me buy!” Last, but probably most important: thank you for sharing!

    1. after the radiology people said they wouldn’t release them to me

      These folks are pretty level-headed: “They’re your records and they belong to you”. The CD production process came down to a checkbox, the tech handed me a CD sleeve, I stopped at the sliding window, they slipped a preprinted disc into the preprinted sleeve, and away I went.

      I’m certain you’re right: Rule 34 applies to those images… [sigh]

      1. That’s handy. When I got an MRI at one point, they were happy to give me the CD. The X ray in question was an old-style physical film one. Good thing my scanner has a transparency adapter!

        1. At one point I had a stack of film MRI images that I managed to scan and turn into a flipbook tour of my skull. It’s around here somewhere, but that’d definitely be oversharing!

  4. For me, high blood pressure has been a very frustrating experience. Restrict salt, no change. Increase exercise, no change. Change diet, no change. Except for the recent change for old timers, why is 120/80 a universal constant? Tall/short, fat/skinny, active/sedentary, white/black, yup 120/80. I’m sure when the first little green man says, “Take me to your leader” there will be a doctor standing nearby stating “You know your blood pressure is a little high?”

    1. The clinical definition of resistant hypertension is when it’s uncontrolled while taking three properly titrated drugs at the same time. I might not have exactly that, but I sure didn’t pass out on the floor at 80/40 when I should have…

      Bah!

  5. Ack! My sympathies; I know, unfortunately, exactly how stressful that experience is. I sincerely hope your outcome is better than mine was — and that seems likely, thankfully! Best of luck.

    1. It’s weird: nothing’s really wrong, but I keep thinking there’s a asteroid incoming. We’ll know more in a few weeks, more or less.

      Sounds like you know whereof you speak; keep on keepin’ on…

      1. I had a brain MRI last month; on my list of projects for my copious free time is figuring out how to segment the brain and skull from the DICOM data and turn them into STL and send them to Shapeways to make a candy bowl for my desk…

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