Imaging features of breast tuberculosis

• Wiem Feki

  Radiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia

• Fatma Hammami

  Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia

• Amina Kammoun

  Radiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia

• Emna Daoud

  Radiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia

• Makram Koubaa

  Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia

• Zaineb Mnif

  Radiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia

Background: Tuberculosis of the breast is a rare disease as its incidence remains low even in countries where tuberculosis’s incidence is high. It is often overlooked and misdiagnosed as bacterial mastitis. The aim of this work was to study the different mammographic and sonographic findings of breast tuberculosis and to outline some imaging features of breast magnetic resonance imaging.

Methods: We conducted a prospective study including 13 patients with tuberculosis of breast between 2020 and 2024.

Results: Mammography was abnormal in 10/10 patients investigated. The main result was an asymmetric density that was diffused in two cases and local in the other cases. Two cases demonstrated multiple mass lesions. Ultrasound was performed in all patients. Six patients presented a well or poorly defined mass lesion. Four patients presented with ductal dilatation with echogenic components. Two cases have fistulized to the skin surface. Breast magnetic resonance imaging was performed in three patients. One patient presented a bilobed mass enhancement with intermediate intense T2. The second patient had multiple confluent mass enhancement with irregular margins.

Conclusions: Breast tuberculosis presents with a wide spectrum of imaging features that can closely mimic both inflammatory and malignant breast conditions. Mammography and ultrasound remain key diagnostic tools, while MRI can provide additional information in complex cases. Awareness of these variable radiologic patterns is essential to avoid misdiagnosis and to guide appropriate clinical and histological evaluation.

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