Figure 4.

40-year-old lactating woman, 9 months post partum, who presented with an enlarged, firm breast, inverted nipple and peau d'orange. Percutaneous ultrasound-guided biopsy revealed invasive ductal carcinoma and ductal carcinoma in situ (DCIS). Pre-operative imaging revealed bone and liver metastases. (a) Bilateral craniocaudal mammogram reveals extremely dense breast tissue. There is diffuse skin thickening (arrow) in the left breast. (b) Sagittal T₁ weighted contrast-enhanced MRI demonstrates multiple masses and diffuse breast enhancement along with pronounced skin thickening (star) – findings are consistent with inflammatory breast carcinoma.