Abstract Body (Do not enter title and authors here): Background: Bilateral breast swelling is a rare and often overlooked presentation of congestive heart failure (CHF) exacerbation. It can mimic other conditions like cellulitis or malignancy, posing a diagnostic challenge. Recognizing this unusual manifestation is crucial for timely diagnosis and appropriate management.

Case Presentation: A 77-year-old female presented with acute onset bilateral breast enlargement, tenderness, and erythema, along with symptoms of CHF exacerbation including dyspnea, orthopnea, and lower extremity edema. Physical examination revealed markedly enlarged, tender breasts. Imaging studies including mammography (Figure 1: Right and left craniocaudal views; Figure 2: Right and left mediolateral oblique views) and breast ultrasound showed diffuse skin and subcutaneous edema without evidence of infection or malignancy. Echocardiography confirmed reduced ejection fraction and diastolic dysfunction. Skin biopsy findings were consistent with CHF-related changes. The patient's symptoms improved with diuresis and optimization of guideline-directed medical therapy for heart failure.

Conclusion: This case highlights breast edema as a rare manifestation of CHF exacerbation that clinicians should be aware of. It can mimic inflammatory breast disorders or malignancy, leading to delayed diagnosis. A high index of suspicion in patients with cardiovascular disease and close collaboration between specialties are key for accurate diagnosis. Treatment involves managing the underlying CHF with diuretics, medical therapy, and supportive measures. Prompt recognition can help alleviate symptoms, prevent complications, and improve patient outcomes.