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To the Editor.—
We read with some interest the CLINICAL NOTE entitled "Unilateral Breast Enlargement: A Complication of an Arteriovenous Fistula and Coincidental Subclavian Vein Occlusion" (237:571, 1977). The unusual circumstance of "congestive enlargement" of the breast associated with an arteriovenous fistula in a chronic dialysis patient was indeed interesting and extremely rare.A more common cause of breast enlargement, usually bilateral, is congestive heart failure. In addition, superior vena caval syndrome secondary to carcinoma of the lung or lymphoma may cause similar congestive enlargement of the breasts. Frequently in these patients dilated veins can be noted in the anterior chest wall above the breasts and may offer a suggestion as to the cause. Unilateral breast enlargement secondary to congestive heart failure can also be seen, and these patients are almost invariably thought to have "inflammatory carcinoma" of the breast. Orange-peel skin is tyypically seen in these breasts. The clue
Maier WP, Rosemond GP. Unilateral Breast Enlargement. JAMA. 1977;238(2):127–128. doi:10.1001/jama.1977.03280020031010
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