Introduction <p>Filariasis is a vector-borne disease endemic in tropical and subtropical regions. Breast is a relatively uncommon site for filariasis that needs timely diagnosis for adequate patient management.</p> Case presentation <p>We report such a case of a 48-year-old female, presenting with a painful progressive right breast lump and intermittent episodes of fever. Ultrasonography revealed a small cyst with filarial dance and a large deep-seated abscess with mobile internal echoes. However, the entire abscess could not be assessed due to its location and size. Henceforth MRI was done, which revealed involvement of the chest wall. CT was also done, which ruled out the possibility of intrathoracic extension of abscess or bony erosions. Incision and drainage of the abscess was done along with the administration of oral medications.</p> Conclusion <p>This case was unique for its presentation as a breast abscess, early identification of filarial dance on ultrasonography, and demonstration of a worm within a cyst on MRI. The timely diagnosis was made in spite of the filarial disease masquerading as an abscess.</p> <p>This case also suggests that MRI breast can help in identifying the lesions with the worm (using eccentric hypointense dot/strand appearance). These lesions if missed or masked by concurrent pathologies on initial ultrasonography can then be reassessed for subsequent cytological evaluation using fine needle aspiration.</p>