case_images: PMC4835870_01
case_images: A 30-year-old female with palpable subcutaneous nodular swelling in the areola from 2 months ago. Local examination shows a nodular swelling (line arrow) with adjacent cord like swelling (solid arrow) in the areolar region of the left breast.
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case_images: The overlying and adjacent skin appeared normal (Figure 1).
case_images: Sonography of the left breast shows two cystic lesions, one in the subcutaneous plane (solid arrow) (A) and the other in the fatty breast parenchyma (line arrow) (B), both showing multiple curvilinear echoes with a dilated interconnecting tubular channel.
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case_images: fig23512
case_images: Few other tubular channels were seen adjacent to these cysts that were not converging towards the nipple and the cysts were presumed to represent focally distended lymphatic ducts (Figure 2A and B).
case_images: A, Color Doppler sonogram shows mixed color Doppler signals due to color motion artifact. B, Spectral trace shows irregular pattern of worm movement.
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case_images: Color Doppler examination of the lesion revealed red, blue, and mixed color Doppler signals that were non-rhythmic, non-pulsatile, and rapidly changed in size and position (Figure 3A). Spectral Doppler trace showed the characteristic pattern of irregular worm movement (Figure 3B).
case_images: A, Follow-up ultrasound showed prominence of lymphatic channels with linear echoes (arrow), and loss of twirling movement (dead worms). B, the color motion artifact was not seen.
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case_images: fig23514
case_images: Twirling movement of the worms was no longer seen that was suggestive of dead worms (Figure 4A and B).