PMC10374383_01
Image showing the appearance of the right breast two months before presentation.
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She was diagnosed approximately ten months prior with triple negative, locally advanced (T3N2M0) breast carcinoma, which progressed to T4bN2M0 disease while on neoadjuvant chemotherapy (Figure 1). She was reviewed two months before the presentation, with a decision to proceed with a modified radical mastectomy.
Image showing a large ulcerated tumor at acute presentation.
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There was a large ulceration of the tumor at the lateral aspect of the right breast with a foul odor and significant drainage of turbid fluid (Figure 2).
CT scan of the chest showing gas within the right breast and tumor invasion into the right pectoral muscles.
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Non-contrast computerized tomography (CT) showed a significant amount of gas throughout the right breast, with an invasion of the tumor into the pectoral muscles (Figure 3).
Image showing recurrent disease on the right chest wall.
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She subsequently defaulted from follow-up for adjuvant therapy and re-presented six months later with a recurrence at the chest wall, confirmed histologically (Figure 4).
PMC10374383_02
Image showing necrotizing skin and soft tissue infections of the left breast. (a) Image of the both breast of the patients showing necrotizing infection involving medial side of the left breast. (b) A closer view of the left breast showing ulceration and infected areas of the left breast (see the marking).
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There was extensive erythema in the medial aspect of the left breast, involving the nipple-areola complex and skin necrosis at the site of the sebaceous cyst (Figure 5).
Chest X-ray posteroanterior view demonstrating suspicion of subcutaneous gas (see arrows).
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A chest X-ray appeared suspicious for subcutaneous emphysema of the left chest wall (Figure 6), and CT confirmed extensive gas within the left breast (Figure 7).
CT scan of the chest showing extensive gas within the left breast (see blue arrows).
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A chest X-ray appeared suspicious for subcutaneous emphysema of the left chest wall (Figure 6), and CT confirmed extensive gas within the left breast (Figure 7).
Image of the open wound after an emergency left mastectomy.
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An emergency left mastectomy was performed, and the wound was left open for delayed closure (Figure 8).
PMC10374383_03
Image of the left breast showing the swelling, redness, and discharging sinus (see arrows). (a) Image of both breast showing that left breast is swollen and larger than the right breast. (b) Closer view of the left breast showing redness of skin of the left breast with a discharging sinus just medial to the left nipple.
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There was mild erythema of the lower inner quadrant of the left breast with a 10 cm x 10 cm tender mass, no palpable crepitus but purulent discharge (Figure 9), and there was no palpable axillary lymphadenopathy.
CT scan of the chest showing gas within the left breast (see blue arrows).
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A CT scan of the chest confirmed extensive gas within the left breast (Figure 10).
Intra-operative image showing the necrotic fascia of the left breast (see blue arrows).
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The infected tissue and necrotic fascia were completely excised (Figure 11).
Post-debridement image showing a clean wound on the left breast (left open).
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The wound was left open with a plan for secondary closure once all infections subside (Figure 12).
PMC10374383_04
Image of the right breast showing desquamation with necrotic patches over the breast.
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The entire right breast was swollen and edematous, and the outer half of her right breast was red with a 10 cm x 10 cm area of desquamation with areas of necrotic underlying tissue (Figure 13).