However, the key to diagnosis is the classic knotted configuration. Depending on the percentage of suture material that has calcified, sutural calcifications can appear linear, curvilinear, or even as an indeterminate cluster. However, sutural calcifications can assume various configurations. The distribution of these calcifications in a straight line along a sutural plane can aid in making a diagnosis. Although they can appear anywhere in the breast, sutural calcifications occur at a site of prior surgery. Sutural calcifications classically have a characteristic tubular curvilinear appearance with a knot seen associated with the surgical tie (Figs. Although the cause of sutural calcifications is incompletely understood, it has been suggested that impaired tissue healing and the foreign suture material serve as a matrix to create an environment conducive to calcium deposition. However, they rarely occur in the absence of radiation after extensive benign breast surgery. It has been suggested that sutural calcifications predominantly occur in areas of the breast subjected to prior radiation therapy. 1C -59-year-old woman with vascular calcification.Ĭ, Mediolateral oblique ( A), craniocaudal ( B), and magnification mediolateral ( C) images of both breasts show linear serpentine tram-track calcifications typical of this benign process. Magnification views often are of value in distinguishing early vascular calcifications from other causes.įig. However, vascular calcifications within smaller vessels and those deposited only on one side of a vessel wall can appear intraductal and present a diagnostic dilemma. Vascular calcifications have a serpentine course rather than the branching ductal pattern seen with other benign and malignant calcifications. Showing a distinctive tram-track (railroad track) configuration paralleling the vessel wall, vascular calcifications are often associated with a visible smooth tubular vessel (Figs. Other systemic processes reported to be associated with mammographic breast calcifications include chronic renal failure and hyperparathyroidism. However, vascular calcifications within the breast represent calcification within the medial layer of the vessel (Mönckeberg medial calcific sclerosis) as opposed to the intimal calcification seen in atherosclerotic disease elsewhere in the body. Other studies have suggested a relationship between visualized breast calcifications and an increased risk for coronary artery disease. Initial studies suggested an association between breast vascular calcifications and diabetes, but later reports have shown this link to be weak. Vascular calcification is not associated with malignancy and thus is among those entities that radiologists can confidently call benign on the basis of imaging alone. Vascular calcification is one of the most common findings encountered in mammography.
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