Case Report Congestive Heart Failure versus Inflammatory Carcinoma in Breast A. Alikhassi, 1 R. Omranipour, 1 and Z. Alikhassy 2 1 Breast Clinic, Cancer Institute, Tehran University of Medical Science, Tehran 1419733141, Iran 2 Emergency Department, Isfahan University, Iran Correspondence should be addressed to A. Alikhassi; afsanehalikhassi@yahoo.co.uk Received 1 February 2014; Accepted 16 March 2014; Published 7 April 2014 Academic Editor: Atsushi Komemushi Copyright © 2014 A. Alikhassi et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Inlammatory breast cancer is a rare highly malignant form of breast cancer. Clinical signs and symptoms with histologic examination usually conirm the diagnosis. here are rare reports of breast edema of congestive heart failure which were diicult to diferentiate from inlammatory carcinoma. he diferential becomes more diicult when congestive heart failure is associated with unilateral breast edema. We present a case of a 70-year-old woman with congestive heart failure associated with unilateral breast edema and skin thickening simulating inlammatory breast carcinoma on mammography. 1. Introduction Congestive heart failure is a common disease especially in elderly population. Its common presentations are well known such as dyspnea, fatigue, weakness, swelling in legs, increased need to urinate at night, and lack of appetite, but familiarizing with the rare presentations of this common disease is also important to prevent unnecessary treatments, cost, and mor- bidity. We report a rare case of unilateral breast enlargement in an elderly woman with congestive heart failure who was clinically suspicious of inlammatory breast cancer. 2. Case Presentation A 70-year-old retired woman presented in breast clinic of cancer institute with complaint of gradual enlargement of right breast with peau d’orange appearance and pitting edema without accompanying arm edema and exertional dyspnea, which happened gradually during the last few months. She did not have fever or dermal erythema. She did not give any history of breast trauma or any previous surgery. She had a past medical history of congestive heart failure (EF 30%). On clinical exam, the patient was cooperative and tachypnoeic and had heart rate of 70/min, regular rhythm, and blood pressure of 130/70 mmHg. here were bilateral crepitations of the lungs, more in the right side. here were bilateral legs pitting edema. Abdominal exam was normal. Clinical breast examination showed an enlarged right breast mainly in dependent part with difusely thickened peau d’orange skin. here was no nipple discharge, nipple retraction, palpable breast mass, or palpable axillary lym- phadenopathy. Full digital mammography revealed skin thickening, cooper ligaments thickening, and edema without any appar- ent mass. Some punctate benign-type microcalciications also spread in both breasts (Figures 1 and 2). Ultrasound showed skin thickening, trabecular promi- nancy, and generalized mild tissue distortion due to edema without apparent mass (Figure 3). Her chest X-ray showed cardiac enlargement and right- side pleural efusion (Figure 4). She was a known case of congestive heart failure with low ejection fraction. Heart failure was considered as a diferential diagnosis for more important inlammatory breast cancer despite, breast edema due to heart failure is a rare entity. We recommended conirming diagnosis by tissue biopsy (skin punch biopsy for ruling out inlammatory breast cancer), but she refused. Alternatively, diuretics were prescribed and she Hindawi Publishing Corporation Case Reports in Radiology Volume 2014, Article ID 815896, 4 pages http://dx.doi.org/10.1155/2014/815896