Mastitis and More: A Pictorial Review of the Red, Swollen, and Painful Breast

Framework and guide for intralesional steroid injections in idiopathic granulomatous mastitis

PURPOSE

Literature on how to perform intralesional steroid injections, a valuable therapy for idiopathic granulomatous mastitis (IGM), is limited. This technical note offers a detailed technical guide on intralesional steroid injections for IGM and provides a framework for long-term follow-up.

METHODS

Ultrasound characterization of IGM severity considering breadth, depth, and ancillary findings was used to guide steroid dosing and injection frequency. Clinical and sonographic breast diagrams were designed for accurate longitudinal tracking of IGM. A step-by-step guide for ultrasound-guided IGM aspirations and intralesional steroid injections was developed.

RESULTS

A detailed approach for ultrasound-guided IGM interventions with clinical and sonographic breast diagrams for longitudinal follow-up is now in practice.

CONCLUSIONS

The treatment approach described provides a framework for multidisciplinary treatment of IGM and offers insights that may contribute to the ongoing development and improvement of management strategies for this challenging disease.

Patient-centered Care: Value Added by Breast Radiologists in the Management of Breast Pain

With the shift of the healthcare system toward patient-centered, value-based care, the role of the breast radiologist is essential and increasingly multifaceted. Beyond sole image interpreters, breast radiologists serve as subject matter experts within multidisciplinary care teams, acting as advocates and initiators into the healthcare system and providing patient-centered care through effective communication and patient education. These vital roles are well demonstrated through the imaging evaluation and management of the most common breast symptom that affects the majority of the patient population-mastalgia. By leveraging the opportunities provided during the evaluation of the symptomatic breast to optimize patient communication and education, as well as integration of care delivery, breast radiologists add significant value to patient care and ultimately improve patient outcomes.

Breast imaging of infectious disease

Infectious diseases of the breast can demonstrate a wide variety of clinical presentations and imaging appearances. Breast abscesses are often a complication of infectious mastitis of the breast. Puerperal mastitis is the most common cause of breast abscess, typically affecting postpartum females. Often diagnosed clinically, it is usually treated with antibiotics without need for imaging. Non-puerperal mastitis is relatively uncommon and typically subareolar in location. Patients can present with asymmetric breast thickening, a palpable lump, nipple discharge, or axillary adenopathy. These presentations can mimic malignancy. Herein, this pictorial review demonstrates imaging findings of common and uncommon infectious processes of the breast and clinically important mimickers of breast infection.

Urgent and emergent breast lesions – A primer for the general radiologist, on‐call resident and sonographer

There are very few true breast emergencies. While infrequent, women do present to emergency departments or urgent care centres with breast-related concerns. In this case-based review, both common and uncommon urgent and emergent breast lesions are presented, emphasising ultrasound characteristics and imaging optimisation to improve accurate diagnosis and appropriate recommendations.

Mammographic and sonographic findings in the breast and axillary tail following a COVID-19 vaccine

Axillary lymphadenopathy on breast imaging after recent coronavirus disease 2019 (COVID-19) vaccination has been reported in the literature as immunization has become more widespread. While muscle edema at the injection site has been observed on MRI secondary to an immune response, ipsilateral breast imaging observations of edema have not been reported to be seen with the COVID-19 vaccinations to date. Mammographic findings such as trabecular and skin thickening, along with increased echogenicity on ultrasound, can be seen with edema secondary to capillary leak or poor lymphatic drainage, and should be considered as a possible etiology for the observed breast edema following a recent COVID-19 vaccine. Inflammatory changes observed in the breast and axillary tail post vaccination described in this case series are transient, but clinically relevant for patients who experience swelling following injection. Similar to evaluations for suspected mastitis, a short interval imaging follow up to confirm resolution may be appropriate for patients with ipsilateral vaccination histories, and could potentially reduce the number of false positive examinations in this clinical scenario. However, inflammatory breast cancer can mimic inflammation and infection, therefore close follow up to resolution is critical as to not miss cancer.