Table 1 Clinical and imaging findings of granulomatous processes of the breast and axilla
From: Granulomatous diseases of the breast and axilla: radiological findings with pathological correlation
Clinical | Imaging | |
|---|---|---|
Infectious | • Aspiration demonstrating bacterial, fungal or parasitic infection | • Mammo: serpiginous calcifications seen with parasitic infection • US/MRI: lymphadenopathy, skin thickening, ill-defined mass, often with sinus tracts and fistulae |
Fat necrosis | • History of trauma | • Mammo: lipid cysts or dystrophic calcifications • US/MRI/CT: fat seen within the centre of mass |
Suture | • Prior surgery | • Mammo: Suture knots seen on mammography |
Silicone | • Breast implants | • Mammo: high-density silicone on mammography • US: snow storm on US • MRI: high-signal on silicone-sensitive sequences • CT: dual-energy CT identifying silicone |
Autoimmune | • Rheumatoid: cutaneous rheumatoid nodules, RF, ANA • GPA: ANCA • Sjögren’s syndrome: dry eyes and mouth, Anti-Ro/SSA, Anti-La/SSB | • Mammo: bilateral ill-defined or irregular masses • US: Bilateral irregular hypoechoic masses |
Sarcoidosis | • ACE elevated, hypercalcaemia or hypercalciuria • Lungs, skin or lymph nodes, less common eyes, liver, heart & brain | • Mammo/US: bilateral masses, asymmetry or architectural distortion • [18F]-FDG-PET: Increased uptake |
IGM | • Pregnant or lactating • Subareolar or entire breast • Affected breast larger, with pain, erythema, swelling or axillary lymphadenopathy • Cultures negative | • Mammo/US: solitary mass, skin thickening and nipple retraction • MRI: marked parenchymal enhancement with sterile micro-abscesses |
Lymph nodes | • Similar aetiologies to breast • Infectious vs non-infectious • Cat bite or scratch to arm | • Mammo/US: lymph nodes enlarged and round • Fistula to skin |