International Journal of Clinical & Medical Images

Introduction: The prevalence of ischemic heart disease is steadily increasing, causing huge morbidity and mortality around the world [1]. The scenario is worse in Indian subcontinent [2]. Atherosclerosis is a generalized disease process [3]. Presence of atherosclerotic changes at one place is indicative of possible involvement of another region. Diabetes which is considered to be coronary equivalent is also rising in epidemic proportions, contributing to rise in coronary artery disease (CAD) [4]. It is therefore imperative to look carefully for all possible markers of atherosclerosis and prevent its life threatening complications.

Case Presentation: A 62-year-old lady, known diabetic and chronic renal disease patient for last 15 years and hypothyroidism for 5 years presented with acute onset chest pain. ECG revealed ST-T inversions suggesting acute coronary syndrome. Chest radiograph was taken which was unremarkable except for aortic knuckle calcification (Image 1). She was managed on the lines of acute coronary syndrome. During her course of stay she also complained of breast discharge. On examination, a small firm lump was palpated in breast and red coloured discharge was observed. Mammogram was advised for the same, which revealed a spiculated mass and axillary lymph node. Incidentally calcification of bilateral mammary arteries was also noted (Image 2). Carotid intima media thickness (CIMT) measurement was also done (Image 3). Increased CIMT measuring approx. 18 mm was observed in mid common carotid artery. A calcified plaque was noted in left carotid bulb.

Discussion: Association of increased coronary artery disease with increased CIMT is well established. Assessment of CIMT is a routine protocol at many Centres in CAD patients [5-7]. Few studies have been published which have suggested that association exists between intramammary arterial calcifications and coronary artery disease [8-10]. Screening mammography is a common procedure for early detection of breast cancer. As the evidence supporting mammary artery calcification as a possible marker for CAD grows, this would establish as an additional utilization of commonly used mammography screening for early detection of breast cancer. This case further supports the belief that presence of mammary artery calcification and CAD coexist. It is therefore essential that mammary artery calcifications and /or aortic calcification must always be reported in radiology reports and the clinicians must not ignore the presence of these calcifications and assess for possible coronary artery disease.