Figure 4b. Images obtained in a 47-year-old woman with peau d’orange. (a) Craniocaudal mammogram of the right breast shows skin thickening (arrows), parenchymal edema, and focal asymmetric density (*) in the outer quadrant. At US, a solid mass 3 cm in longest diameter with irregular contour was seen in this location. (b) Craniocaudal mammogram of the left breast is normal. (c) Transverse US scans of the lower inner quadrant of the right breast show marked skin thickening (*), dilated lymphatic channels (arrowheads), and focal areas of parenchymal acoustic shadowing (arrows). Histologic subtype and size: invasive ductal carcinoma, 3.3 cm in longest diameter.