SEAT-BELT INJURIES OF THE BREAST - FINDINGS ON MAMMOGRAPHY AND SONOGRAPHY

OBJECTIVE. The purpose of this study was to determine the mammographic and sonographic findings of injuries of the breast caused by seat bel ts in automobile accidents. The imaging findings of such injuries must be differentiated from those of carcinoma, so that inappropriate trea tment is avoided. MATERIALS AND METHODS. Five patients who had breast injuries caused by seat belts with shoulder restraints between 1988 an d 1993 and who underwent mammography were included in this study. Four of these women had imaging studies done in our department, and one wa s examined elsewhere, The initial mammograms for four patients were ob tained 1-2 months after trauma to the breast. For the fifth patient, t he initial study was obtained 13 months after injury. For all women, f ollow-up examinations were performed from 3 months to 4 years after in jury. Two patients also underwent sonography of the breast during the course of their evaluation. RESULTS. At 1-2 months after breast injury caused by a seat belt, mammograms showed thin-walled fat density cyst s in a linear distribution and, in less dense breasts, an associated 2 -3-cm band of increased density. The band of increased density was not seen in more dense breasts. These findings correlated with the line o f contusion across the breast and resultant fat necrosis, which ultima tely led to the formation of lipid cysts. By 3-4 months after the inju ry, the lipid cysts and contusion were less apparent, and a line of fi brosis had developed. On sonography, the lipid cysts were smoothly mar ginated; such cysts may be either anechoic or hypoechoic. Parenchymal calcification may develop 3.5-4 years after such an injury. CONCLUSION . Mammograms in women with breast injuries caused by seat belts show a reas of contusion, lipid cysts, and parenchymal calcifications occurri ng in a bandlike distribution corresponding to the path of the seat be lt shoulder restraint across the chest. Lipid cysts are seen sonograph ically as smoothly marginated anechoic or hypoechoic nodules.