Figure 2. A-E.

Targeted ultrasound images from (A) through (D) depicting different grades of idiopathic granulomatous mastitis (IGM) on different patients. (A) A fistula tract shows the drainage of purulent content on the background B-mode image and color Doppler map displays ongoing hyperemia within the wall of the tract. This finding corresponds to Grade II. (B) Hypoechoic solid-like mass measuring about 3.4 cm on long axis with diffuse increment on echogenicity of surrounding tissue obtained at gray-scale ultrasound at 9 o’clock position of the right breast in a 28-year-old postpartum woman presenting with denial of breastfeeding by her baby on the affected breast. Following 3 weeks of conservative treatment due to a lack of symptom resolution with progression in the size of the lesion, a biopsy was performed, and the result was IGM. This lesion demonstrates the earliest course of disease initiation and corresponds to grade I. (C) In another patient with a history of periductal mastitis on the contralateral breast prior 2.5 years was referred to the tertiary university hospital for further work-up of the lesion on the right side. The abscess formation (measurement markers) is clearly depicted within the extremely IGM-involved periareolar breast side. These findings correspond to grade III. (D) Elastosonographic image of the biopsy-proven IGM lesion. Color box (E) indicates the stiffness of tissue based on elasticity properties of the region of interest with red depicting the hardest and blue the softest.