Breast Filariasis Diagnosed by Real Time Sonographic Imaging: A Case Report

Abstract

A 30-year-old woman presented with a palpable subcutaneous nodule in the areolar region of the left breast. Sonomammographic examination revealed 2 cystic lesions showing typical “filarial dance” as vigorous twirling movement of multiple curvilinear echoes with mixed red blue color Doppler signals that was non-rhythmic, nonpulsatile, and the characteristic pulse Doppler trace due to irregular worm movement. Real time sonographic demonstration of these typical features is pathognomonic for filariasis, especially in endemic areas and treatment should be initiated without delay on the basis of ultrasound.

A Young Man in a Rural Breast Clinic

“…The larvae of both filariasis and guinea worm have a propensity for lymphatic channels in the body, and both will show small, serpiginous calcifications in a non-ductal distribution on mammography. In filariasis, ultrasound may show nonrhythmic, non-pulsatile mixed red blue color Doppler signal from irregular worm movement known as the "filarial dance" (8)(9)(10)(11).…”

Bilateral breast filariasis mimicking inflammatory breast carcinoma

“…Upper outer quadrant is the most common region to be affected 5. Usually, breast filariasis presents as non-tender breast swelling1; however, cases with peaud’orange and lymphadenopathy have also been reported 6…”

“…Filariasis is commonly encountered in Africa, Asia and some South American countries 1. In India, endemic areas include Odisha, Bihar, Uttar Pradesh, Gujarat, Andhra Pradesh and Tamil Nadu.…”

Filarial dance sign in breast lump

“…Other associated findings such as erythema of skin, peau de orange, fever or axillary lymphadenopathy can be seen 2. Ultrasound is the diagnostic modality of choice with the classical ‘filarial dance sign’ 3 4. Microfilariae levels in blood examination can be low so a haemtological workup can be negative.…”