Presentation
A mass in the axillary tail of the left breast.
Patient Data
The mammogram images show a non-specific homogeneous amorphous density in the submammary space. There were no previous studies for comparison. I am not sure what the "pipe cleaner" linear densities are but because they are bilateral I suppose they may represent needle tracts from the introduction of the PAH ? In this patient the injection was from both axillas.
A palpable mass axillary...
A palpable mass axillary tail of the Lt breast.
The ultrasound images show a heterogenous tissue in the submammary space and on the left, tracking toward the axilla. In real time the substance can be seen to move, rotate and swirl on ultrasound imaging. The middle image shows a small superficial simple cyst in the breast parenchyma.
Case Discussion
The case demonstrates PAH breast injections. Polyacrylamide hydrogel (PAH) was one of the substances historically used to augment breast tissue (along with paraffin and silicon). It was used in this patient 20 years ago in what was then the Soviet Union. The needle injection was via the axilla or inframammary fold into the submammary space.
Not a common finding in Western Canada but I suppose it depends on where you work. This case showed migration of the PAH from the submammary space toward the left axilla where it formed a palpable mass lesion.
The reference below is a very readable historical summary of the augmentation of breast tissue (and other protuberances) and well worth reading for some perspective if you are involved in senology. To my mind also a social commentary on who we are and who we would like to be.
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