Breast calcifications following electrical defibrilla- tion: An unusual mammographic appearance

Microcalcifications develop in the breast for a number of reasons. Most causes are benign, representing fibrocystic changes, involuting fibroadenomas, post-traumatic fat necrosis, or adenosis. Not uncommonly, however, microcalcifications identified on a mammogram are the result of atypical hyperplasia or frank malignancy such as ductal carcinoma in situ (DCIS). Ideally, mammographers would biopsy only malignant calcifications and not the benign ones. Frequently, however, the distinction between malignant and benign is not easily made. In order to make this distinction, we scrutinize the morphology, distribution, and stability of the calcifications. Calcifications that are layering, have central lucency, are popcorn-like, or follow along arterial walls are benign and require no additional evaluation. Calcifications that are pleomorphic or fine linear and branching in nature are concerning for malignancy, and the need for biopsy is clear. In most cases, calcifications that are not clearly benign must undergo tissue sampling to exclude malignancy. We discuss a woman who developed regions of heterogeneous calcifications in her left breast six months after transthoracic electrical cardiac defibrillation. Stereotactic vacuum-assisted biopsy of the calcifications revealed fibrosis and fat necrosis, and no evidence of malignancy. Correlation between the imaging and pathologic findings led us to believe that electrical defibrillation was the cause of the patient’s unusual breast calcifications. While calcifications induced by electrical defibrillation may mimic those of carcinoma, knowledge of this as a potential cause of breast calcifications may help to avoid biopsy in some patients.