Inflammatory breast disease: mammographic spectrum

Breast Infection: A Review of Diagnosis and Management Practices

Mastitis is a common condition that predominates during the puerperium. Breast abscesses are less common, however when they do develop, delays in specialist referral may occur due to lack of clear protocols. In secondary care abscesses can be diagnosed by ultrasound scan and in the past the management has been dependent on the receiving surgeon. Management options include aspiration under local anesthetic or more invasive incision and drainage (I&D). Over recent years the availability of bedside/clinic based ultrasound scan has made diagnosis easier and minimally invasive procedures have become the cornerstone of breast abscess management. We review the diagnosis and management of breast infection in the primary and secondary care setting, highlighting the importance of early referral for severe infection/breast abscesses. As a clear guideline on the management of breast infection is lacking, this review provides useful guidance for those who rarely see breast infection to help avoid long-term morbidity.

Abscess in the non-lactating breast: radiodiagnostic aspects

The value of mammography and ultrasound in evaluating abscesses in the non-lactating breast was assessed in 20 patients. Inflammatory breast masses in the non-lactating period are uncommon and the clinical diagnosis can be very difficult when signs of inflammation are absent. There were 20 patients ranging in age from 25 to 60 years in the present study; the mean age was 39.35 years. Patients presented with a lump and/or pain without other clinical signs of inflammation. Mammography was performed to exclude malignancy. Mammograms showed an ill-defined mass in 11 patients and an area of focal increased density in seven patients. Ultrasonograms showed echoic masses with central echopenia in 17 cases and central septation in three cases. Half the lesions were subareolar and half were peripheral. Two of 20 patients were treated by excision, three by incision and drainage, eight by aspiration and seven by antibiotics. The combination of mammographic and sonographic features may enable the radiologist to recognize this entity, thus preventing unnecessary surgery.

Mammographic and sonographic spectrum of non-puerperal mastitis

The goal of this study was to explore possible specific mammographic and sonographic features in women with non-puerperal mastitis (NPM), in order to make an accurate diagnosis and prevent unnecessary surgical procedures. From a group of 93 patients with NPM diagnosed between 1987 and 1992, the mammograms of 41, the sonograms and cytology of 47, and the histology of seven patients were retrospectively reviewed. Follow-up was performed on those without histology. In 20 of the 47 patients the inflammation was located subareolarly. In 50% of those with non-subareolar lesions, mammography showed a circumscribed lesion. Sonographically, all patients had an identifiable lesion either well or poorly defined. The majority of the lesions were cystic, but in 23 of 47 cases solid components were seen. Signs of infection in cystic lesions were observed in 25 of 47 cases. Posterior shadowing was not observed. During the follow-up period no breast malignancy was found. It is concluded that NPM has no specific mammographic or sonographic sign. Diagnosis should be made with additional diagnostic assessment, such as FNAB, which was diagnostic in all cases.