Multimodality imaging of breast trauma: Diagnosis and management

Purpose: Breast traumas include road accident, assaults, falls or other minor events; the diagnosis is often delayed, despite several medical imaging techniques because of the priority to most relevant organs and anatomical districts involved in traumatic events. Aim of the study was to evaluate the imaging in breast traumas, the differential diagnosis and correlation with breast cancer and the medical or surgical management of each case described. Methods: We performed a retrospective study over a period between February 2010 to June 2017. All patients diagnosed with breast injuries were included in the study. Breast clinical examination, mammography, ultrasonography and, in selected cases, Magnetic Resonance (MRI) and ultrasound-guided fine needle aspiration cytology were used for the diagnosis. Logistic regression models were used to estimate unadjusted and adjusted odds ratio and corresponding 95% confidence interval. Results: Over the study period, 55 patients had a breast trauma; there were 12 cases of major event and 43 minor traumas. 2 males and 53 females have been included. Mean age was 47yo (range 27-71 yo). In 11 cases, surgical therapy was necessary, in 3 cases medical therapy and in 2 follow-up have been performed. In 10 cases, also a breast cancer has been diagnosed, but no association between breast trauma and the risk of breast cancer was observed (odds ratio: 0.85; IC 95%: 0.41-1.75; P: 0.665). Conclusion: Breast traumas are underestimated if a major event occurred; imaging diagnosis of breast trauma requires often a multimodality approach and can be difficult expecially if a breast cancer also occurs. A dedicated breast radiologist is necessary for a correct differential diagnosis and to palinify a terapeutical approach and follow-up.