Non-Mass Image-Forming Low Echoic Areas on Breast US: Pathologic Correlation

PURPOSE: We wanted to analyze the mammographic and clinical findings of the non-mass image-forming low echoic areas seen on breast ultrasonography (US) and investigate their pathologic results. MATERIALS AND METHODS: Sixty-nine patients with 72 non-mass image-forming low echoic areas seen on breast US and who had undergone mammography and biopsy were included in this study. The mammographic findings were divided into 2 groups: 1) the negative or probably benign group and 2) the suspicious for malignancy group. The US findings were divided into 3 groups: focal, segmental and diffuse distributions. The clinical findings were divided into 2 groups: the non-palpable and palpable groups. We investigated the pathologic results according to each group. RESULTS: Of the 72 lesions, 49 (68.1%) were benign and 23 (31.9%) were malignant. On the mammography, 42 (93.3%) of the 45 negative or probably benign findings and 7 (25.9%) of 27 suspicious for malignancy findings were pathologically benign (p < 0.001). On the US, 38 (76%) of the 50 focal distributions and 11 (52.4%) of 21 segmental distributions were benign (p = 0.090). Thirty (73.2%) of the 41 nonpalpable lesions and 19 (61.3%) of the 31 palpable lesions were benign (p = 0.609). CONCLUSIONS: A non-mass image-forming low echoic area seen on breast US was malignant at a higher rate when it was found in conjunction with suspicious mammographic finding. There was no significant correlation between the distribution of the non-mass image-forming low echoic areas on US or their palpability and the pathologic results.

Evaluation of Mammographic Phantom Images Using JPEG2000 Image Compression

PURPOSE: To determine the usefulness of compression standard JPEG2000 for compression of mammographic images. MATERIALS AND METHODS: Image of a mammographic phantom was compressed using JPEG2000 at ratios of 10:1, 20:1, 30:1, 40:1, 50:1 and 60:1. The sizes of the images were compared, and scores were recorded by counting the numbers of fibers, groups of specks and masses seen in each phantom image. More than four fibers, three groups of specks and three masses and a total score of 10 were considered acceptable. RESULTS: The size of a DICOM image was 17,042 KB, a TIFF image was 8,324 KB, the original JPEG image was 1,506 KB and the most compressed image (50:1) above an acceptable total score of 10 was 43 KB. In each category, the compression image of fiber was acceptable up to compression ratio of 50:1 (score of 5), groups of specks was acceptable up to 60:1 (score of 3) and mass was acceptable up to 50:1 (score of 3.5). The total score, which was acquired by adding up the individual scores of all three categories, for a compression ratio of 50:1 was 12 and was acceptable, but the total score for 60:1 was 8 and was not acceptable. CONCLUSION: The compression standard JPEG2000 is an efficient means for compressing mammographic images at high ratios without compromising diagnostic value.

Breast Cancer from the Excisional Scar of a Benign Mass

Breast cancer developing from a surgical scar is rare; this type of malignancy has been reported in only 12 cases to date. Herein, we report on a 52-year-old female who developed infiltrating ductal carcinoma in a surgical scar following excision of a benign mass. Two years previously, the patient underwent surgery and radiotherapy for invasive ductal carcinoma of the contralateral breast. The initial appearance of the scar was similar to fat necrosis; it was observed to be progressively shrinking on follow-up sonography. On the two year follow-up ultrasound, the appearance changed, an angular margin and vascularity at the periphery of the scar were noted. A biopsy and subsequent excision of the scar were performed; the diagnosis of infiltrating ductal carcinoma of the scar was confirmed.

Spontaneous Disappearance of Microcalcifications in Breast Papillary Carcinoma: Case Report

Spontaneous disappearance of breast calcification has rarely been reported. The majority of cases of spontaneously resolving calcifications have been concerned with benign processes. We report here on breast papillary carcinoma that showed spontaneously resolving microcalcifications without newly developed parenchymal changes on the follow-up mammogram.

Analysis of Previous Screening Examinations for Patients with Breast Cancer

PURPOSE: We wanted to improve the quality of subsequent screening by reviewing the previous screening of breast cancer patients. MATERIALS AND METHODS: Twenty-four breast cancer patients who underwent previous screening were enrolled. All 24 took mammograms and 15 patients also took sonograms. We reviewed the screening retrospectively according to the BI-RADS criteria and we categorized the results into false negative, true negative, true positive and occult cancers. We also categorized the causes of false negative cancers into misperception, misinterpretation and technical factors and then we analyzed the attributing factors. RESULTS: Review of the previous screening revealed 66.7% (16/24) false negative, 25.0% (6/24) true negative, and 8.3% (2/24) true positive cancers. False negative cancers were caused by the mammogram in 56.3% (9/16) and by the sonogram in 43.7% (7/16). For the false negative cases, all of misperception were related with mammograms and this was attributed to dense breast, a lesion located at the edge of glandular tissue or the image, and findings seen on one view only. Almost all misinterpretations were related with sonograms and attributed to loose application of the final assessment. CONCLUSION: To improve the quality of breast screening, it is essential to overcome the main causes of false negative examinations, including misperception and misinterpretation. We need systematic education and strict application of final assessment categories of BI-RADS. For effective communication among physicians, it is also necessary to properly educate them about BI-RADS.

Ultrasonographic and Mammographic Findings of Nodular Sclerosing Adenosis

PURPOSE: To evaluate the ultrasonographic and mammographic findings of cases of nodular adenosis. MATERIALS and METHODS: We evaluated 22 lesions with a pathologically proven nodular adenosis from five hospitals for three years. We excluded adenosis cases combined with other breast diseases. The findings of ultrasonography and mammography were retrospectively interpreted in consensus by two radiologists that were experienced in breast imaging according to the BI-RADS criteria. RESULTS: The age of the patients was 29-56 years with a mean age of 43.4 years. Ten lesions were biopsied with a 14-gauge core needle, seven lesions were biopsied with an 11-gauge vacuum-assisted mammotome and five lesions were removed by surgical excision. Mammography was performed in 15 patients and distinct abnormalities were seen in seven cases. These abnormalities consisted of an indistinct irregular mass, three circumscribed masses and three focal asymmetries. Calcifications were not seen in all of the masses. Ultrasonography was performed in 22 patients, revealing 13 irregular shaped lesions 8 oval shaped lesions and one round shape lesion. The margin was either circumscribed (n = 7) and not circumscribed (n = 15) in the lesions. The orientation of mass was parallel in 13 lesions and not parallel in 9 lesions. The boundary was an abrupt interface in all of the cases. The echogenecity of the mass was hypoechoic in 15 cases, isoechoic in 4 cases, hyperechoic in 2 cases and complex echogenic in one case. Nineteen of the cases showed no posterior feature and one case showed combined features. The final categories by the BI-RADS criteria were category 3 in three cases and category 4 in 19 cases (C4a 11, C4b 8). CONCLUSION: Nodular adenosis mostly presents as category 4 on ultrasonography. Therefore, a differential diagnosis with malignancy is difficult to determine. However, the findings of lesions highly suggestive of being malignant such as a spiculation or echogenic halo, are rare. On mammography, it is commonly obscured.

Peculiar Mammographic and Ultrasonographic Findings of a Retained Silastic Drain in the Breast

Foreign bodies, such as surgical sponges or drains, are sometimes retained after surgical procedures.1 Retention of a drain in the breast tissue postoperatively is an unusual complication. This report describes two cases of characteristic sonographic findings related to retained silastic drains following breast surgery.

Solitary Schwannoma in the Breast: A Case Report

Schwannoma (neurilemoma) is a benign nerve tumor derived from the nerve sheath. The most common locations are the flexor surfaces of the extremities, and the head and the neck. Schwannoma of the breast is unusual. To our knowledge, few studies have reported the radiologic appearance of schwannoma in the breast and there has been only one report from Korea (1-3). This tumor can be clinically and radiologically considered to be fibroadenoma, which is a common benign tumor of the breast. We describe the mammographic and sonographic findings of a case of schwannoma in the breast.

Comparison of the Accuracy of Mammography, Ultrasonography and MRI for Evaluating Residual Tumor after Neoadjuvant Chemotherapy for Breast Cancer

PURPOSE: The purpose of our study was to determine the relative accuracy of mammography, ultrasonography and MRI for evaluating residual tumor after neoadjuvant chemotherapy for breast cancer, as compared with the pathological results. MATERIALS AND METHODS: From December 2004 through August 2005, 13 patients who had mammography, ultrasonography and MRI performed for evaluating tumor response were enrolled in our study from a total of 47 patients who received neoadjuvant chemotherapy for breast cancer. The therapy response was defined by ultrasonography that was able to compare the images taken before and after therapy, and each imaging was retrospectively analyzed by two board-certified radiologists who specialized in breast imaging. The presence or absence of residual tumor was investigated and the tumor measurement according to the imaging was divided into underestimating, being equal to or overestimating the size of the residual tumor, compared with that of the pathological results. The relative accuracy of these modalities was then assessed. RESULTS: Eight of 13 patients showed a partial response and 5 patients showed stable lesion. Agreement rates about the residual tumor, as measured by mammography, ultrasonography and MRI and then compared with the pathological results, were 39%, 54% and 77%, respectively. Of the three methods, MRI agreed with the pathological results significantly more often, but it may overestimate (8%) or underestimate (15%) (p = 0.102). When there was disagreement with the pathological results, mammography exhibited a tendency to underestimate (38%) and ultrasonography exhibited a tendency to overestimate (31%). CONCLUSION: MRI had a higher relative accuracy than did mammography and ultrasonography for evaluating the residual tumor in patients receiving neoadjuvant chemotherapy for breast cancer. However, MRI may overestimate (8%) or underestimate (15%) the residual tumor.

Intracystic Papillary Carcinoma with Extensive Hemorrhage of the Breast: Sonographic and Advanced MR Findings: A Case Report

Intracystic papillary carcinoma (IPC) of the breast is very rare, and it has a much better prognosis than the other types of breast carcinoma. We experienced a case of intracystic papillary carcinoma that we diagnosed in an 83-year-old-woman. MR imaging of the IPC shows a multicystic appearance with a subacute or chronic stage of intracystic hemorrhage. The contrast-enhanced MR imaging demonstrates enhancement of the cyst wall and mural nodules, and this modality proved to be successful for making an accurate preoperative diagnosis.

Pregnancy-Associated Breast Disease: Radiologic Features and Diagnostic Dilemmas

In this paper, we evaluate the radiological features of pregnancy-associated breast lesions and discuss the difficulties in diagnosis by imaging. We selected patients who were diagnosed with pregnancy-associated breast lesions during the previous 5 years. All patients complained of palpable lesions in the breast and underwent ultrasonographic (US) examination, the first choice for examination of pregnancy-related breast lesions. Any suspicious lesions found by the US were recommended for a US-guided core biopsy, US-guided fine needle aspiration (FNA), or surgery. Various breast lesions were detected during pregnancy and lactation, including breast cancer, mastitis and abscesses, lactating adenoma, galactoceles, lobular hyperplasia, and fibroadenomas. The imaging features of pregnancy-associated breast lesions did not differ from the features of non-pregnancy-associated breast lesions; however, some pregnancy-associated benign lesions had suspicious sonographic features. A US-guided core biopsy was necessary for differentiating benign from malignant. In patients with breast cancer, the cancer was often advanced at the time of diagnosis. In conclusion, various pregnancy-related breast lesions were detected and the imaging of these lesions had variable findings. Breast ultrasound could be an excellent imaging modality for diagnosis and differentiation between benign and malignant lesions. However, when the imaging results are suspicious, a biopsy should be performed to obtain a pathologic diagnosis.

The Clinical Significance of Normal Mammograms and Normal Sonograms in Patients with Palpable Abnormalities of the Breast

PURPOSE: We wanted to evaluate the clinical significance of normal mammograms and normal sonograms in patients with palpable abnormalities of the breast. MATERIALS AND METHODS: From Apr 2003 to Feb 2005, 107 patients with 113 palpable abnormalities who had combined normal sonographic and normal mammographic findings were retrospectively studied. The evaluated parameters included age of the patients, the clinical referrals, the distribution of the locations of the palpable abnormalities, whether there was a past surgical history, the mammographic densities and the sonographic echo patterns (purely hyperechoic fibrous tissue, mixed fibroglandular breast tissue, predominantly isoechoic glandular tissue and isoechoic subcutaneous fat tissue) at the sites of clinical concern, whether there was a change in imaging and/or the physical examination results at follow-up, and whether there were biopsy results. This study period was chosen to allow a follow-up period of at least 12 months. RESULTS: The patients' ages ranged from 22 to 66 years (mean age: 48.8 years) and 62 (58%) of the 107 patients were between 41 and 50 years old (58%). The most common location of the palpable abnormalities was the upper outer portion of the breast (45%) and most of the mammographic densities were dense patterns (BI-RADS Type 3 or 4: 91%). Our cases showed similar distribution for all the types of sonographic echo patterns. 23 patients underwent biopsy; all the biopsy specimens were benign. For the 84 patients with 90 palpable abnormalities who were followed, there was no interval development of breast cancer in the areas of clinical concern. CONCLUSION: Our results suggest that we can follow up and prevent unnecessary biopsies in women with palpable abnormalities when both the mammography and ultrasonography show normal tissue, but this study was limited by its small sample size. Therefore, a larger study will be needed to better define the negative predictive value of combined normal sonographic and mammographic findings.

The Clinical Significance of Normal Mammograms and Normal Sonograms in Patients with Palpable Abnormalities of the Breast

PURPOSE: We wanted to evaluate the clinical significance of normal mammograms and normal sonograms in patients with palpable abnormalities of the breast. MATERIALS AND METHODS: From Apr 2003 to Feb 2005, 107 patients with 113 palpable abnormalities who had combined normal sonographic and normal mammographic findings were retrospectively studied. The evaluated parameters included age of the patients, the clinical referrals, the distribution of the locations of the palpable abnormalities, whether there was a past surgical history, the mammographic densities and the sonographic echo patterns (purely hyperechoic fibrous tissue, mixed fibroglandular breast tissue, predominantly isoechoic glandular tissue and isoechoic subcutaneous fat tissue) at the sites of clinical concern, whether there was a change in imaging and/or the physical examination results at follow-up, and whether there were biopsy results. This study period was chosen to allow a follow-up period of at least 12 months. RESULTS: The patients' ages ranged from 22 to 66 years (mean age: 48.8 years) and 62 (58%) of the 107 patients were between 41 and 50 years old (58%). The most common location of the palpable abnormalities was the upper outer portion of the breast (45%) and most of the mammographic densities were dense patterns (BI-RADS Type 3 or 4: 91%). Our cases showed similar distribution for all the types of sonographic echo patterns. 23 patients underwent biopsy; all the biopsy specimens were benign. For the 84 patients with 90 palpable abnormalities who were followed, there was no interval development of breast cancer in the areas of clinical concern. CONCLUSION: Our results suggest that we can follow up and prevent unnecessary biopsies in women with palpable abnormalities when both the mammography and ultrasonography show normal tissue, but this study was limited by its small sample size. Therefore, a larger study will be needed to better define the negative predictive value of combined normal sonographic and mammographic findings.

Sequential Change in the Findings of Fat Necrosis on US, MRI and Tissue Specimen Radiogram Correlating with Histopathologic Findings: Experimental Study in Pigs

PURPOSE: This study compared the sequential findings of ultrasound, MRI and tissue specimen radiograms of experimentally induced fat necrosis in pigs with the histopathology findings. MATERIALS AND METHODS: Fat necrosis was induced in five experimental groups containing three pigs per group (3-day, 2-week, 4-week, 6-week and 8-week groups), which were divided according to the amount of time after inducing fat necrosis until when the tissue specimen was obtained. Ultrasound (US) and MRI (T1 weighted images, T2 weighted images, STIR sequence, T1 fat-suppressed contrast enhanced images) were obtained. X-ray tissue specimen radiograms were obtained after sacrificing the pigs. The changes in the findings of these imaging modalities were compared with the histopathology findings. RESULTS: Ultrasound showed the lipase-induced masses of fat necrosis to be isoechoic (47%) and mixed echoic (42%) masses in 3-day group, mixed (56%, 41%) and hypoechoic (42% and 59%) masses in the 2-week and 4-week groups respectively, and hypoechoic (67% and 56%) masses in the 6-week and 8-week groups. MRI showed the T1 weighted images to have significantly high rate of isosignal intensity in the 3-day, 2, 4 and 6-week groups, but the isosignal intensity lesions decreased gradually while the low signal intensity lesions increased with time. The T2 weighted images showed that the high signal intensity lesions were the main type of lesion in the early stage but the isosignal intensity lesions increased markedly in the late stage. The STIR (short tau inversion recovery) sequence showed that all the masses of fat necrosis were observed to have high signal intensity in the 3-day group, and the high signal intensity lesions decreased while the isosignal intensity lesions increased significantly during the follow-up period between 2 weeks to 8 weeks. All the masses of fat necrosis were enhanced on the fat-suppressed contrast-enhanced T1 weighted images. Among the total 45 cases X-ray tissue specimen radiograms, fat necrosis was observed as a radiopaque mass in 28 cases (62%). Among these 28 cases, calcifications within the masses were observed in 4 cases from the 8-week group and 1 case from 6-week group. Two cases from 2-week group were observed as spiculated masses. The histopathology findings of fat necrosis were acute inflammatory cell infiltration, edema and hemorrhage in the 3-day group, the proliferation of fibroblasts, connective tissue and capillaries around the fat necrosis in the 2-week group. However, the number of vessels decreased gradually and the fibrosis had progressed further in the 4, 6 and 8-week groups. CONCLUSION: The sequential findings of fat necrosis on US, MRI and tissue specimen radiogram were correlated with the histopathology findings. These results may be helpful for the differentiating fat necrosis from more ominous breast masses.

Screen-Film Mammography and Soft-Copy Full-Field Digital Mammography: Comparison in the Patients with Microcalcifications

OBJECTIVE: We wanted to compare the ability of screen-film mammography (SFM) and soft-copy full-field digital mammography (s-FFDM) on two different monitors to detect and characterize microcalcifications. MATERIALS AND METHODS: The images of 40 patients with microcalcifications (three patients had malignant lesion and 37 patients had benign lesion), who underwent both SFM and FFDM at an interval of less than six months, were independently evaluated by three readers. Three reading sessions were undertaken for SFM and for FFDM on a mammography-dedicated review workstation (RWS, 2K x 2.5K), and for FFDM on a high-resolution PACS monitor (1.7K x 2.3K). The image quality, breast composition and the number and conspicuity of the microcalcifications were evaluated using a three-point rating method, and the mammographic assessment was classified into 4 categories (normal, benign, low concern and moderate to great concern). RESULTS: The image quality, the number and conspicuity of the microcalcifications by s-FFDM (on the RWS, PACS and both) were superior to those by SFM in 85.0%, 80.0% and 52.5% of the cases, respectively (p 0.01). The mammographic assessment category for the microcalcifications in the three reading sessions was similar. CONCLUSION: s-FFDM gives a superior image quality to SFM and it is better at evaluating microcalcifications. In addition, s-FFDM with the PACS monitor is comparable to s-FFDM with the RWS for evaluating microcalcifications.

The Usefulness of Additional Bilateral Whole Breast US with Negative Mammographic Results in Asymptomatic Women

PURPOSE: We wanted to evaluate the clinical utility of performing bilateral whole breast US as a subsequent diagnostic method along with mammography in asymptomatic women. MATERIALS AND METHODS: From May 2002 to Dec 2004, we conducted 3998 examinations on 3638 patients with negative findings on the clinical examination and negative mammographic results, and those breast tissues having a BI-RADS category 2, 3, or 4 density were further evaluated by performing bilateral whole breast US. The patients' age distribution ranged from 24 to 66 years (mean age: 43.6 yrs). The abnormalities were compared with core or vacuum assisted core biopsy, operations, and follow up US. For the normal cases, we used the clinical notes and the statistical data from the Korean Central Cancer Registry. RESULTS: For 3998 examinations of 3638 women who were examined with bilateral whole breast US, pathologic confirmations were available for 433 patients and follow-up data were available for 35 patients. The sensitivity, specificity, the positive predictive value and the cancer detection rate of using additional whole breast US were 50, 92.6, 0.6 and 0.5, respectively. The two cancers that were detected only on US were minimal breast cancer. CONCLUSION: Although all the breast cancers that were detected only on US were minimal breast cancers, performing bilateral whole breast US revealed a low cancer detection rate and a high false positive. Therefore, further studies will be needed to investigate the role of US as a screening tool.

Establishment of Quality Assessment Standard for Mammographic Equipments: Evaluation of Phantom and Clinical Images

PURPOSE: The purpose of this study was to establish a quality standard for mammographic equipment in Korea and to eventually improve mammographic quality in clinics and hospitals throughout Korea by educating technicians and clinic personnel. MATERIALS AND METHODS: For the phantom test and on site assessment, we visited 37 sites and examined 43 sets of mammographic equipment. Items that were examined include phantom test, radiation dose measurement, developer assessment, etc. The phantom images were assessed visually and by optical density measurements. For the clinical image assessment, clinical images from 371 sites were examined following the new Korean standard for clinical image evaluation. The items examined include labeling, positioning, contrast, exposure, artifacts, collimation among others. RESULTS: Quality standard of mammographic equipment was satisfied in all equipment during on site visits. Average mean glandular dose was 114.9 mRad. All phantom image test scores were over 10 points (average, 10.8 points). However, optical density measurements were below 1.2 in 9 sets of equipment (20.9%). Clinical image evaluation revealed appropriate image quality in 83.5%, while images from non-radiologist clinics were adequate in 74.6% (91/122), which was the lowest score of any group. Images were satisfactory in 59.0% (219/371) based on evaluation by specialists following the new Korean standard for clinical image evaluation. Satisfactory images had a mean score of 81.7 (1 S.D.=8.9) and unsatisfactory images had a mean score of 61.9 (1 S.D=11). The correlation coefficient between the two observers was 0.93 (p<0.01) in 49 consecutive cases. CONCLUSION: The results of the phantom tests suggest that optical density measurements should be performed as part of a new quality standard for mammographic equipment. The new clinical evaluation criteria that was used in this study can be implemented with some modifications for future mammography quality control by the Korean government.

The Benefit of Sonography in Pregnancy-associated Breast Cancer

PURPOSE: To evaluate the sonographic, mammographic and MRI features of pregnancy-associated breast cancer with the major focus on the sonographic benefit in a diagnosis of pregnancy associated breast cancer. MATERIALS AND METHODS: From 1998 to 2002, sonography was performed on a total 7 patients (age 23 to 38 years), who were pathologically diagnosed with breast cancer during pregnancy. Six of those patients underwent mammography. Five patients underwent a breast MRI, preoperatively. The radiological findings were evaluated retrospectively. Six patients underwent surgery and 1 patient underwent a core biopsy and chemotherapy. The histological, nuclear grading and pathological staging were evaluated. RESULTS: The sonographic findings showed a mass with irregular shapes (n=6), irregular margins (n=6), a non-parallel orientation (n=5), complex echo patterns (n=5). Associated findings could be observed in 3 patients, including Cooper's ligament thickening (n=2), edema (n=2), skin thickening (n=1) and axillary lymphadenopathy (n=3). The sonographic findings were positive and showed masses in 6 patients. All the patients had a dense breast in mammography. The mammographic findings included masses (n=4), masses with microcalcifications (n=2), masses with axillary lymphadenopathy (n=3), calcifications alone (n=1), an asymmetric density alone (n=1), extremely dense breasts with negative findings (n=2). A breast MRI showed an irregular shaped mass (n=4) with a rim-like enhancement (n=3), linear ductal enhancement without a mass (n= 1), and the time intensity cure revealed the typical pattern and level of enhancement in the carcinoma. CONCLUSION: Sonography is a valuable tool for diagnosing pregnancy-associated breast cancer. However, mammography should be performed if there is a suspicious lesion on sonography in order to confirm the pregnancy-associated breast cancer. Mammography has a lower sensitivity during pregnancy due to the physiologic changes in the breasts. However, calcifications and associated findings are helpful in confirming pregnancy-associated breast cancer. physicians should not consider a rapidly growing lump in the breast during pregnancy to be benign and should perform radiological examinations and imaging-guided biopsies.

Interested Cases Encountered in the Breast Clinic

Many patients present to the breast clinic with variable symptoms. The degree of palpability is the important symptom for patients and clinicians. Both mammography and ultrasonography play an important role in the diagnosis of breast diseases by indicating the cause of the symptoms and aiding in the selection of treatment for the disease. Sometimes, however, we meet unexpected results. In this paper, we will illustrate the ultrasonographic and mammographic findings of interesting, unusual or perplexing breast cases in order to familiarize ourselves with these breasts through these cases and thereby assist in future diagnosis.

Unilateral Breast Edema: Spectrum of Etiologies and Imaging Appearances

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.