Focal necrosis mimicking breast cancer following coronary bypass grafting

Abstract

BackgroundBreast cancer can be diagnosed easily in most cases. However, occasionally, we are faced with some conditions that can mimic it. These may include inflammations, benign tumors, cysts, hematomas, or, more rarely, focal necrosis.Case presentationThis report presents a case of focal breast necrosis following myocardial revascularization with the left internal mammary artery, which is a very rare condition, with only few cases described in the literature. The necrosis becomes usually apparent a few days or weeks after the surgery and is often coincidental with the dehiscence of sternotomy with necrosis of wound edges. As it mostly affects the skin, it can be easily recognized. Also, our patient developed a dehisced sternotomy shortly after the surgery but there were no obvious objective changes on the breast. The condition was first dominated only by non-specific subjective symptom—pain. Later, a lump in the breast occurred, when the sternotomy had already healed. Moreover, an enlarged lymph node was palpable in the axilla. Because of non-typical symptoms, the condition was suggestive of breast cancer for a relatively long time. The patient had suffered from a very strong pain until she was treated by mastectomy with a good clinical result.ConclusionsMammary necrosis following the coronary artery bypass is rare. In most cases, it manifests on the skin shortly after the surgery concurrently with dehisced sternotomy, so it can be easily diagnosed. However, in sporadic cases, the symptoms may occur later and may mimic breast cancer. Our objective is to raise awareness of this rare condition.

Ischaemic breast necrosis following coronary artery bypass grafting using left internal mammary artery: understanding the risks

“…Six patients presented with breast necrosis without sternal wound dehiscence. Delayed breast necrosis was misdiagnosed as breast malignancy and mastectomy was performed in two of the patients 12,16 …”

“…We report sternal wound dehiscence and breast necrosis following a LIMA harvest during CABG. The sternal wound dehiscence following LIMA harvest is a known complication 1,2 but there are very few case reports of breast necrosis 4–17 following a CABG.…”

Environmental Contamination of Arsenic and its Toxicological Impact in Cardiovascular Tissues of Patients with Coronary Heart Disease

“…In our case, the person is relatively young (45 years old) and can be suspected of arsenic as the main cause of the tissue damage. Then, appear not to be apparent that arsenic may cause necrosis in cardiovascular tissues of the man (44). However, at the light of the new knowledge, a critical issue is how to distinguish between apoptosis and necrosis (45).…”