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Sonographic Features of Gynecomastia

Objective. The purpose of this study was to identify sonographic features of gynecomastia. Methods..A retrospective analysis was performed on all male patients with breast symptoms imaged with breast sonography over a 5‐year period. Breast sonograms in 158 men were jointly reviewed by 3 investigators. Sonograms were assessed for the presence or absence of a mass: (1) if mass present, (a) location of the mass, (b) vascularity, (c), axis, (d) appearance of posterior tissues, and (e) tissue echo texture; and (2) if mass absent, anteroposterior (AP) depth at the nipple (increased if >1 cm). Results. Of the 237 men with breast symptoms, 79 with only mammography were excluded. Of the 158 who had sonography with or without mammography, 5 without gynecomastia were also excluded. A total of 153 men included in the study presented with pain (n = 38), a lump (n = 95), both pain and a lump (n = 17), or nipple discharge (n = 3). Nine of 153 with gynecomastia had a biopsy. A total of 219 sonographic examinations were performed, which revealed 73 masses (33%): 20 (27%) nodular, 20 (27%) poorly defined, and 33 (45%) flame shaped. All masses were retroareolar, with 57 (78%) hypoechoic, 54 (73%) avascular, 60 (82%) parallel to the chest wall, and 47 (64%) without posterior enhancement or shadowing. Of the 146 without masses (67%), 141 (97%) had increased AP depth at the nipple. Conclusions. Gynecomastia is a clinical diagnosis, and mammography is the primary imaging modality when indicated. However, if sonography is used when mammography is declined or when mammography is inconclusive, it is important to recognize the various described patterns of gynecomastia to avoid unnecessary biopsy based on sonographic findings.