Breast panniculitis has rarely been described, even though the condition can trigger a workup for malignancy when the patient presents with a tender palpable nodule. Apart from causing local fat necrosis, panniculitis is frequently associated with systemic symptoms and visceral involvement is not uncommon. Differential diagnosis with other conditions such as malignancies, subcutaneous panniculitis-like T-cell lymphoma, connective tissue diseases or cellulitis is important because the treatment differs. The imaging findings can provide valuable information and might prove especially useful when the clinical and biopsy features are equivocal.