Vandana Mukesh Dialani MD, Presenter: Nothing to Disclose

Tejas S. Mehta MD, Abstract Co-Author: Nothing to Disclose

Janet K. Baum MD, Abstract Co-Author: Consultant, iCAD, Inc

To identify sonographic features of gynecomastia.

A retrospective analysis was performed on all male patients with breast symptoms presenting for imaging over a 5 year period. Breast ultrasounds in 153 males were jointly reviewed by the investigators without knowledge of clinical history. Ultrasounds were assessed for 1) masses (not present, nodular, ill-defined, spiculated or flame shaped), 2) location of mass (retroareolar, other) 3) vascularity (absent, present or not done), 4) lesion axis (parallel or perpendicular to chest wall, or neither), 5) appearance of posterior tissues (enhancement, shadowing, neither), 6) Tissue echotexture (hypoechoic, hyperechoic, mixed), and 7) AP diameter at the nipple (defined as increased if more than 1cm).

153 men (age 18-97 yrs), presented with pain (n=38), lump (n=95), both (n=27), or nipple discharge (n=3). 66 had bilateral and 87 had unilateral symptoms. Final diagnosis based on clinical and imaging findings and/or histology was gynecomastia in 148 (97 %), angiolipoma in 2 (1.2%), abscess in 1 (0.6%), hematoma in 1 (0.6%) and breast cancer in 1 (0.6%). The 5 patients without gynecomastia had atypical imaging findings leading to intervention and histologic diagnosis. 9/148 with gynecomastia also had biopsy. 214 ultrasounds were performed of symptomatic breasts in patients with final diagnosis of gynecomastia. These revealed 69 (32%) masses: 16 nodular, 20 ill-defined, 33 spiculated or flame shaped. Most of the masses were retroareolar (n=69; 100%), hypoechoic (n=57; 83%), avascular (n=54; 78%), parallel to the chest wall (n=60; 87%), and showed no enhancement or shadowing (n=47; 68%). Of the 145/214 (68%) without masses, 143 (99 %) had increased AP diameter with hypoechoic (n=76; 53%) or mixed (n=61; 43%) tissue echotexture.

Gynecomastia is the most common cause of breast symptoms in men. In patients with high clinical suspicion of gynecomastia an ultrasound should suffice to make a diagnosis, if the described patterns are recognized.

In patients with high clinical suspicion of gynecomastia an ultrasound should suffice to make a diagnosis.

Dialani, V, Mehta, T, Baum, J, Sonographic Features of Gynecomastia.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4432856.html