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I reviewed with great interest “Unknown Challenge #8: Pneumomastia,” published on June 15, 2020 (1). An additional and potentially dangerous differential diagnosis that can be considered in patients presenting with air tracking along the breast tissue is ozone therapy. The Food and Drug Administration has stated that ozone is a “toxic gas with no known useful medical applications” (2). Consequently, this type of therapy is generally not used in the United States. Medical doctors have long considered ozone dangerous, as the O3 molecule is unstable; however, naturopaths continue to study and utilize ozone for a variety of ailments, including infections, musculoskeletal complaints, cardiovascular disease, and cancer therapy (3). At our comprehensive breast imaging center, we see patients undergoing naturopathic alternative therapies in addition to, or instead of, conventional medical therapies (Figure 1). Please consider this additional differential diagnosis and its potential associated dangers.

H.O.F. discloses consultant work for IBM Watson and ViewPoint Medical for work unrelated to this manuscript.

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