Unilateral breast edema: spectrum of etiologies and imaging appearances

Abstract

Breast edema is defined as a mammographic pattern of skin thickening, increased parenchymal density, and interstitial marking. It can be caused by benign or malignant diseases, as a result of a tumor in the dermal lymphatics of the breast, lymphatic congestion caused by breast, lymphatic drainage obstruction, or by congestive heart failure. Here we describe several conditions, that cause unilateral breast edema with the aim of familiarizing radiologists with these disease entities.

Fig. 1

Inflammatory breast cancer in a 40-year-old woman with a palpable mass and erythematous change of the right breast. Mediolateral mammograms show diffuse increased density, trabecular thickening, skin thickening, and a spiculated mass on the right upper portion (arrows).

Fig. 2

Metastasis in a 43-year-old woman with left breast swelling and skin change. The patient had a signet ring cell carcinoma on her stomach. Biopsy specimens of the hypoechoic nodule in the left breast were evaluated microscopically and immunohistochemically, which included estrogen receptor (ER) and gross cystic disease fluid protein-15 (GCDFP-15), for differentiating primary and metastatic breast cancer. However, the immunohistochemical results for ER and GCDFP-15 were negative, indicating a metastatic signet ring cell carcinoma of the breast. A & B, Mediolateral and craniocaudal mammograms show diffuse increased density, trabecular thickening, and skin change without a definite focal mass. C, Sonogram shows diffuse skin and subcutaneous edema and two suspicious hypoechoic nodules in the left upper outer.

Fig. 3

Breast lymphoma in a 35-year-old woman with a right breast enlargement. Mediolateral oblique mammogram shows diffuse increased opacity throughout the entire right breast with skin thickening.

Fig. 4

Mastitis in a 37-year-old woman with breast pain, swelling, and an erythematous change of right breast of 2 weeks duration. After antibiotic treatment the clinical symptoms disappeared. A & B, Mediolateral and craniocaudal mammogram show diffuse skin thickening and accentuated Cooper's ligament.

Fig. 5

Tuberculous abscess in an 81-year-old woman with a painful swelling of the left breast of 2 months duration. A & B, Mediolateral and craniocaudal mammogram show skin thickening, trabecular thickening, and diffuse increased density.

Fig. 6

Congestive heart failure in a 47-year-old woman who complained of dyspnea, dizziness, and a swelling of the left breast. A, Initial craniocaudal mammogram shows diffuse increased density with reticular fascial thickening and marked skin thickening. B, Follow-up left craniocaudal mammogram after 4 weeks of diuretic therapy showing significant resolution of the increased density and skin thickening. C, Sonogram shows marked skin thickening, and an echogenic subcutaneous fat layer with tubular and reticular anechoic structures, suggestive of dilated lymphatics (left), as compared with the normal side (right).

Fig. 7

Post-radiotherapeutic change in a 71-year-old woman due to a poorly differentiated carcinoma of the breast. (A & B) Mediolateral and craniocaudal mammogram show a spiculated mass in upper outer portion of right breast. (C) After partial mastectomy and radiotherapy, this craniocaudal mammography showed diffuse increased density and trabecular and skin thickening as compared to the later 2-year follow-up mammography (D).