case_images: PMC4227985_01
case_images: Breast panniculitis with vasculitis on axial non-contrast CT scan of chest. An oval nodule is located within the central inner region of the right breast (thick arrow) with increased infiltration of the subcutaneous adipose tissue (thin arrow). Pulmonary alveolar infiltrations within the right lower lobe of lung are also present (curved arrow).
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case_images: PMC4227985_01_40064_2014_1346_Fig1_HTML.jpg
case_images: Fig1
case_images: The chest CT revealed diffuse patchy airspace consolidation and patchy pulmonary alveolar infiltrates with fine interstitial thickening over both lung fields, most severe within the left upper lobe and right lower lobe (Figure 1). Incidentally noted on chest CT was a small oval nodular lesion measuring approximately 1.0 cm x 0.6 cm over the inferior and medial aspect of the right breast with infiltration within the subcutaneous adipose tissue (Figure 1).
case_images: Breast panniculitis with vasculitis on ultrasound. a. A heterogeneously hypoechoic nodule within the right breast measures 1.35 cm x 0.39 cm in size (arrows). b. A faint echogenic interface (short arrows) and partially instinct margin (long arrows) of the nodule are present. c. Normal skin (short arrow) and skin thickening (long arrow) over the nodule are observed. d. Additional hypoechoic satellite nodules (short arrows) are visualized. e. Blood flow signals increase in and around the nodule on color Doppler (arrow). f. A sono-guided biopsy of the nodule with an 18-gauge core biopsy needle (arrow) is performed.
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case_images: PMC4227985_01_40064_2014_1346_Fig2_HTML.jpg
case_images: Fig2
case_images: Breast sonography revealed an oval, heterogeneous, predominantly hypoechoic nodule within the right breast measuring 1.35 cm x 0.39 cm in size between 3 and 4 o'clock, 2 cm from the nipple, with a faint echogenic interface, partially indistinct margin, and increased blood flow signals on color Doppler (Figure 2). Skin thickening and additional hypoechoic satellite nodules were noted in the surrounding area (Figure 2). As the patient refused mammography or MRI, a sono-guided biopsy of the lesion was performed using an 18-gauge core biopsy needle (Figure 2).
case_images: Pathologic specimens of breast panniculitis with vasculitis from the excisional biopsy. a. and b. Histologic section shows primarily fibroadipose tissue within the right breast with chronic inflammatory cells infiltration and fibrotic change. (hematoxylin & eosin, original magnification, 40x and 100x). c. Chronic inflammatory cells infiltrate around and in a small vessel with the lumen obliterated (hematoxylin & eosin, original magnification, 100x). d. A vasculitis involves a medium size artery and small vessels (Elastic van Gieson stain, original magnification, 100x).
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case_images: PMC4227985_01_40064_2014_1346_Fig3_HTML.jpg
case_images: Fig3
case_images: Pathology from the excisional biopsy confirmed breast panniculitis, consisting of fibroadipose tissue with prominent inflammation and fibrotic change in a vague perivascular pattern (Figure 3). Histologic section further revealed a vasculitis involving medium size arteries and small vessels without giant cells or granuloma formation (Figure 3).