Mammogram, CT scan, and MRI of angiosarcoma of the breast

This 55-year-old patient has angiosarcoma of the left breast associated with radiation therapy for breast carcinoma 8 years prior. She presented with breast enlargement and bluish discoloration of the skin that was clinically initially felt to correspond to an "expanding hematoma." The mammogram of the left breast (A) reveals multiple nodular masses (arrows) in the outer part of the breast, with overall increased trabecular background markings and skin thickening (small arrowhead). The CT scan through the mid-chest (B) shows a skin nodule (large arrowhead), breast nodules (arrows), and thickened skin (dashed arrow) of the left breast. There are increased trabecular background markings throughout the left breast. The T1-weighted, fat-suppressed MRI postcontrast images show three suspiciously enhancing masses (arrows in C) and thickened and enhancing skin (thick arrow in D). The T1-weighted MRI image in axial projection (E) shows nodular foci of skin thickening (double arrow).