European Journal of Radiology 59 (2006) 327–330 Clinical, mammographic and ultrasonographic features of blunt breast trauma Gianluca Gatta a,* , Antonio Pinto a , Stefania Romano a , Antonietta Ancona b , Mariano Scaglione a , Luca Volterrani c a Department of Diagnostic Imaging, “A. Cardarelli” Hospital, 80131 Naples, Italy b Department of Diagnostic Imaging, Senology Section, San Paolo Hospital, Bari, Italy c Department of Radiology, University of Siena, Siena, Italy Received 12 April 2006; received in revised form 14 April 2006; accepted 14 April 2006 Abstract Evaluation of acute breast injury depends largely on the findings at physical examination. Patients may not initially remember the traumatic event to the breast, and mammography may be the first radiographic study to suggest this history, particularly if it shows findings of fat necrosis. Clinical, mammographic and sonographic findings resulting from non-iatrogenic trauma to the breast can be mistaken for signs of malignancy, especially because trauma often is not considered as a cause for such findings. In this paper some of the manifestations of blunt traumatic injury to the breast are presented. Familiarity with mammographic and sonographic findings of breast trauma is essential for the radiologist to avoid unnecessary biopsy and to avoid overlooking breast cancer. © 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: Breast; Blunt trauma; Mammography; Ultrasonography 1. Introduction The breast can be subject to direct trauma in a motor vehicle accident, with bruises and abrasions of the chest wall occurring in 16% of seat belt-restrained victims, as reported in a large prospective surgical series [1]. The severity of the previously reported injuries ranges from small haematomas to an avulsed breast that required emergent mastectomy to stop bleeding [2]. Clinical, mammographic and sonographic findings resulting from non-iatrogenic trauma to the breast can be mistaken for signs of malignancy, especially, because trauma often is not con- sidered as a cause for such findings. Furthermore, patients may not initially recall the traumatic event. In this article, some of the manifestations of blunt traumatic injury to the breast are illustrated. * Corresponding author at: Via Tasso 480 (P.co Matarazzo), 80127, Naples, Italy. Tel.: +39 081 649425; fax: +39 081 7472996. E-mail address: ggatta@sirm.org (G. Gatta). 2. Clinical findings Breast injury after motor vehicle accidents usually results from compression on the breast tissue by the shoulder restraint of the seat belt to cause a wide band of contusion. In cases of severe injury, the inflammatory reaction to the area of crushed tissue and haemorrhage manifests as fat necrosis, which progresses over 1–2 months to form lipid cysts. As the lipid cysts and contusion resolve, a line of fibrosis develops, which may become calcified after 3–4 years. Clinically, fat necrosis may be asymptomatic and without abnormal phys- ical findings, or it may result in an indurated mass some- times associated with ecchymosis, retraction, or thickening of the overlying skin, and symptoms of pain and tender- ness. The lesion characteristically is situated near the skin or areola, since these are the sites within the breast that are the most vulnerable to trauma. Fat necrosis occurs most often in the fatty, pendulous breasts of middle-aged women [3]. Mondor’s disease (Figs. 1 and 2) can be another conse- quence of breast trauma: it is a rare benign breast condi- tion characterized by thrombophlebitis of the superficial veins 0720-048X/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2006.04.024