Inflammatory breast disease: A pictorial essay with radiological-pathological correlation

Autoimmune Mastitis in a Patient with Behcet's Syndrome: A Case Report with Rapid Changes in Radiologic Features and Characteristic Pathologic Findings

Breast manifestations of autoimmune diseases are rare but may present as localized disease or as part of a systemic disease. The most common clinical presentations of autoimmune mastitis are palpable masses and mastalgia, but patients can also be asymptomatic. Its radiological features are nonspecific and varied; it usually appears as an irregular hypoechoic mass or ill-defined hypoechoic nonmass lesion that mimics malignancy, with or without duct ectasia on breast ultrasonography. On breast MRI, segmental or regional nonmass enhancement is observed. However, due to its nonspecific and rapid changes in its clinical and radiological features, its diagnosis is often challenging and delayed. Herein, we present a rare case of mastitis with mammary duct ectasia in a patient with Behcet's syndrome and its rapid changes in imaging features on serial radiologic studies. Furthermore, we review the literature focusing on the radiologic and histopathologic characteristics of autoimmune mastitis.

Imaging spectrum in tropical breast infections

While breast carcinoma is the most feared pathology in women with breast lumps, infections continue to be an important aetiology, especially in countries with low to middle socio-economic status. The breast infections or mastitis can present as acute painful breast or recurrent episodes of breast lumps with or without pain. The common causes include puerperal, non-puerperal, and idiopathic mastitis whereas uncommon causes like tuberculosis, filariasis, hydatid and other parasitic infections are still seen in developing countries. Imaging with digital mammography may be difficult due to pain or inadequate due to increased breast density. Ultrasound serves as the modality of choice for detailed assessment in these patients. Since the imaging features are often overlapping with malignancy, biopsy is almost always indicated. However, there are certain imaging findings that may point to the diagnosis of mastitis and can help in accurate radiologic-pathologic correlation. This article aims to illustrate the varied clinico-radiological features of patients with tropical breast infections.

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

Clinically, acute mastitis presents as a red, swollen, and painful breast. Targeted ultrasound can be performed to evaluate the extent of infection and for an underlying abscess. Noncomplicated mastitis or a small fluid collection may respond to oral antibiotics without further intervention, but a larger or more complex abscess may require single or serial percutaneous aspiration. Breast infections, particularly those complicated by an abscess, can have a prolonged clinical course, and close follow-up is required. Since the clinical presentation and imaging features of acute infectious mastitis can overlap with other etiologies, such as inflammatory breast cancer and idiopathic granulomatous mastitis, a percutaneous biopsy may be indicated to accurately diagnose patients.

Sonographic features of inflammatory conditions of the breast

Inflammatory conditions of the breast can be a diagnostic challenge, and ultrasound is a proven valuable tool in this setting. In acute infective conditions, ultrasound is often a superior tool to mammography due to the impracticality of applying compression to the breast and the increased parenchymal density of these often younger patients. Although infective processes comprise the majority of inflammatory conditions in the breast, not infrequently other various disease processes can masquerade as infections. In particular, inflammatory breast cancer can be easily misdiagnosed as an infective process and sonography can play an important role in expediting the correct diagnosis. Furthermore, aspiration, drainage and biopsy are frequently required in managing breast inflammation and breast disease generally, and ultrasound is the most practical imaging modality facilitating such interventions. This article provides a review of the ultrasound characteristics of some of the more frequently encountered inflammatory disorders of the breast which span a spectrum of acute to chronic conditions. The various conditions in this report are described in terms of their specific sonographic imaging features as well as pathogenesis, common clinical presentations, and aspects of management are outlined where appropriate.

Imaging Features of Inflammatory Breast Disorders: A Pictorial Essay

Inflammatory breast disorders include a wide array of underlying causes, ranging from common benign infection, non-infectious inflammation and inflammation resulting from underlying breast malignancy. Because it is at times difficult to distinguish mastitis and breast cancer based on clinical features, awareness of detailed imaging features may be helpful for better management of inflammatory breast disorders. Therefore, this pictorial essay intends to demonstrate radiologic findings of a variety of inflammatory breast disorders, using selected cases with mammography, ultrasound and magnetic resonance images.