1
|
Pal B, Shaikh O, Vijayakumar C, Prakash S, Balasubramanian G, Kumbhar U. A Randomized Controlled Trial Comparing Ultrasonography-Guided Needle Aspiration and Surgical Drainage for the Management of Breast Abscess. Cureus 2023; 15:e50956. [PMID: 38249226 PMCID: PMC10800148 DOI: 10.7759/cureus.50956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Background A breast abscess is a localized collection of inflammatory exudate in breast tissue. It is more common in lactating women. Treatment of the breast abscess is usually by incision and drainage, which is accompanied by extensive trauma, lengthy surgical incisions, psychological distress, surgical scar, and discomfort during dressing changes. Recent research has shown that ultrasonography-guided needle aspiration is an alternative to incision and drainage for breast abscess treatment, has superior cosmetic outcomes, and has fewer costs. However, there are no clear guidelines for the same. The primary objective of this study was to assess and contrast the outcomes and efficacy of two approaches in the treatment of breast abscesses: ultrasonography-guided needle aspiration and conventional incision and drainage. Methods This was a single-center, prospective, randomized, controlled, non-inferiority trial. Patients with breast abscesses were randomized either to receive needle aspiration or incision drainage. Patients with lactational breast abscesses were encouraged to breastfeed from either breast. The antibiotic was given for 10 days to all the patients. The study's main focus was on the primary outcome, which was the failure rate. Additionally, several secondary outcomes were examined, including postoperative pain, time required for healing, presence of residual abscess or recurrence, formation of fistulas, and the assessment of scar appearance. Results A total of 44 patients were randomized to 23 and 21 in each arm. There was no statistical difference in treatment failure (p-value=0.862), fistula formation (p-value=1.00), and recurrence (p-value=1.00). There was a significant statistical difference in healing period (p-value <0.001), scar formation (p-value <0.0001), continuation of breastfeeding (p-value=0.005), and clinical resolution (p-value=0.002). There was a significant reduction in post-intervention pain in the needle aspiration group than in the other group (p-value <0.001). Conclusion This study showed a significant difference in postoperative pain, healing time, the continuation of breastfeeding, and scar formation in the needle aspiration group, favouring minimally invasive treatment for breast abscess. However, due to the small sample size, we could not conclude that ultrasonography-guided needle aspiration of the breast abscess is non-inferior to the conventional incision and drainage.
Collapse
Affiliation(s)
- Bishal Pal
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Oseen Shaikh
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sagar Prakash
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Gopal Balasubramanian
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Uday Kumbhar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| |
Collapse
|
2
|
Suga Y, Kuehn T, W/Ammanuel G, Knfe G, Teklewold B. Review of Breast Abscess Cases at a Tertiary Hospital in Addis Ababa, Ethiopia. Int J Womens Health 2023; 15:433-442. [PMID: 36999001 PMCID: PMC10046216 DOI: 10.2147/ijwh.s391686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
Background Breast abscess is a prevalent cause of morbidity in women occurring in 0.4% to 11% of patients after mastitis. The majority are benign, but worrisome etiologies such as inflammatory cancer and concomitant immune-compromising diseases should be addressed when a non-lactating patient presents with a breast abscess. The problem is high among women in developing countries (1). The purpose of this study is to assess the magnitude, clinical presentation, and treatment of breast abscess patients at a tertiary hospital. Methodology A descriptive cross-sectional study was conducted on all patients treated for breast abscesses from September 2015 to August 2020. A retrospective review of the clinical records was performed to collect data on sociodemographic, clinical, and management data using a data extraction form. The collected data were then cleaned and entered into SPSS for analysis. Results Two hundred and nine patients were included in this study over 5 years and lactational breast abscess (LBA) is more prevalent,182 (87.1%) than non-lactational breast abscess (NLBA), 27 (12.9%). Bilateral breast abscesses occurred in 16 (7.7%) patients. Patients presented at a median duration of 11 days and had been breastfeeding for 2 or more months. A spontaneously ruptured abscess was detected in, 30 (14.4%) of the patients. Comorbidities identified include diabetes mellitus (DM) in, 24 (11.5%), Hypertension in, 7 (3.3%), HIV in, 5 (2.4%) of patients. All women were treated with Incision and Drainage and had a median volume of 60 mL of pus drained. Following surgery, all patients were given ceftriaxone in the immediate post-operative days and either cloxacillin,167 (80.3%), or Augmentin,41 (19.7%) antibiotics p on discharge. Follow-up data were available for 201 (96.1%) patients and the recurrence rate was 5.8%. Conclusions and Recommendations Lactational breast abscesses are more common than non-lactational breast abscesses, particularly in primiparas. DM is the most common comorbidity in non-lactational breast abscesses and health-seeking behavior should be improved given the delayed presentation.
Collapse
Affiliation(s)
- Yisihak Suga
- Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Correspondence: Yisihak Suga, Tel +251913470780, Email ;
| | - Thorsten Kuehn
- Department of Gynecological Oncology and Gynecologic Surgery, Klinikum Esslingen, Esslingen, Germany
| | - Gessesse W/Ammanuel
- Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Goytom Knfe
- Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Berhanetsehay Teklewold
- Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
3
|
Snider HC. Management of Mastitis, Abscess, and Fistula. Surg Clin North Am 2022; 102:1103-1116. [DOI: 10.1016/j.suc.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
4
|
Lou L, Ma W, Liu X, Shen H, Wang H, Lv H. Application of arthroscopic system in the treatment of lactational breast abscess. BMC Surg 2022; 22:397. [PMID: 36401263 PMCID: PMC9673404 DOI: 10.1186/s12893-022-01845-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose Optimal treatment of breast abscesses has been controversial. Herein, we report an innovative method for the operative treatment of lactational mammary abscesses. Methods Nineteen lactating patients diagnosed with breast abscesses were enrolled in the study, and abscess debridement and drainage were performed using an arthroscopic system. The clinical characteristics of the patients were recorded to evaluate the feasibility, efficacy, and cosmetic results of arthroscopic surgery for breast abscesses. Results All 19 patients were cured and did not relapse within the 6-month-follow-up period. One patient stopped breastfeeding due to breast leakage. All patients were satisfied with the postoperative appearance of the breast. Conclusion Arthroscopic debridement and drainage are effective treatment methods for lactational breast abscesses, with a high cure rate, few complications, and satisfactory cosmetic outcomes.
Collapse
|
5
|
Hartawan IGAGU, Yani MVW, Senapathi TGA, Widnyana IMG, Ryalino C, Sinardja CD, Pradhana AP. Postoperative Recovery Quality after General Anesthesia in Patients Undergoing Emergency Surgery. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The quality of post-operative patient recovery is part of the indicators of the quality of anesthesia services. However, side effects were still found in post-operative patients, which resulted in the speed and quality of recovery (QoR) and an increase in the length of stay for patients in the hospital.
AIM: This study aims to describe the quality of a patient’s recovery after general anesthesia for patients undergoing surgery in the emergency room.
MATERIALS AND METHODS: This research is a descriptive study with a cross-sectional design conducted from February to July 2020. Patients numbered 52 people who are patients aged 18–59 years who are willing to fill out a questionnaire QoR-40 on the day after surgery. All data were analyzed using the statistical program SPSS. The median of the QoR-40 score will be used as a cutoff point between good and poor recovery quality.
RESULTS: Fifty-two patients responded to the study with a median age of 44 years. The median QoR-40 score was 188, with most of the good category’s recovery quality (55.8%). The middle-aged group showed better QoR (68.2 vs. 31.8%), as well as the female compared to male (65 vs. 35%). Patients who underwent neurosurgery showed poor recovery 61.9 vs. 38.1%).
CONCLUSION: More than half of the patients who underwent emergency surgery under general anesthesia in the emergency room of Sanglah Hospital have good recovery quality.
Collapse
|
6
|
Du Z, Liu L, Qi X, Gao P, Wang S. Treatment of lactational breast abscesses with cavity diameter larger than 5 cm via combined ultrasonography-guided percutaneous catheter placement and hydrostatic pressure irrigation. J OBSTET GYNAECOL 2021; 42:385-388. [PMID: 34030591 DOI: 10.1080/01443615.2021.1907558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study reports on our experience of treating lactational breast abscesses larger than 5 cm via ultrasonography (US)-guided percutaneous catheter placement and hydrostatic pressure irrigation. Twelve cases of puerperal single breast abscesses larger than 5 cm were collected. These patients were treated with US-guided percutaneous catheter placement and hydrostatic pressure irrigation combined with oral antibiotics. All 12 patients using US-guided treatment were completely successful without conversion to open surgical drainage. The range of recovery time was 5-16 days, and no major complications occurred. The patients were satisfied with the appearance of the scar, and there were no reports of recurrence during the follow-up period.Overall, US-guided percutaneous catheter placement and hydrostatic pressure irrigation are successful strategies for the treatment of lactational breast abscesses larger than 5 cm. These methods not only reduce the treatment time and improve the patients' clinical course but also provide cosmetic effects.IMPACT STATEMENTWhat is already known on this subject? The current consensus on breast abscess treatment is that lesions <3 cm can be effectively treated by aspiration alone, lesions >3 cm require catheter drainage, lesions <5 cm have proven to be safe and effectively treated by US-guided ultrasound therapy, and lesions >5 cm, whether multi-loculated or longstanding, require surgical incision and drainage.What do the results of this study add? We tried to use this method to increase the cure rate of US-guided minimally invasive treatment for large abscesses. The results showed that all patients were cured successfully, requiring no further surgical intervention. Moreover, no complications occurred, and no patients developed sequelae. During the three-month follow-up period, there was no evidence of recurrence in any case.What are the implications of these findings for clinical practice and/or further research? Questions remain regarding the treatment's generalisability, potentially lengthy hospitalisation, and technical limitations of the existing instrumentation. Long-term follow up and larger sample size Randomised clinical trials studies are still needed to rigorously and scientifically ensure the method's benefits over conventional open surgery in the future.
Collapse
Affiliation(s)
- Zhihui Du
- Department of Ultrasonography, Ordos Center Hospital, Ordos, China
| | - Lei Liu
- Department of Ultrasonography, Ordos Center Hospital, Ordos, China
| | - Xing Qi
- Department of General Surgery, Ordos Center Hospital, Ordos, China
| | - Peisen Gao
- Department of Ultrasonography, Ordos Center Hospital, Ordos, China
| | - Shumin Wang
- Department of Ultrasonography, Ordos Center Hospital, Ordos, China.,Department of Ultrasonography, Peking University Third Hospital, Beijing, China
| |
Collapse
|
7
|
Woodard GA, Bhatt AA, Knavel EM, Hunt KN. Mastitis and More: A Pictorial Review of the Red, Swollen, and Painful Breast. JOURNAL OF BREAST IMAGING 2021; 3:113-123. [PMID: 38424840 DOI: 10.1093/jbi/wbaa098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 03/02/2024]
Abstract
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.
Collapse
Affiliation(s)
| | - Asha A Bhatt
- Mayo Clinic, Department of Radiology, Rochester, MN
| | | | - Katie N Hunt
- Mayo Clinic, Department of Radiology, Rochester, MN
| |
Collapse
|
8
|
Stachs A, Stubert J, Reimer T, Hartmann S. Benign Breast Disease in Women. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:565-574. [PMID: 31554551 DOI: 10.3238/arztebl.2019.0565] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Most clinical breast changes in women are benign; in only 3% to 6% of cases are they due to breast cancer. How- ever, there is a lack of up-to-date, evidence-based treatment recommendations for the various benign differential diagnoses. METHODS Selective literature search of PubMed from 1985 to May 2019, including current national (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften [Association of Scientific Medical Societies in Germany]) and inter- national guidelines. RESULTS Mastalgia and fibrocystic changes are common (around 50% of all women over the age of 30). Fibroadenomas occur in 25% of women; they are the most common benign tumors of the breast and do not require treatment. With most benign breast changes the risk of dedifferentiation is very low. However, it is important in the differential diagnosis to distinguish between such benign changes and breast cancer or changes that carry a risk of malignancy. Complex cysts, for example, carry a risk of malig- nancy of 23% to 31%, papillary lesions 16% , and radial scars 7%. Where there is doubt, histological confirmation should be sought by means of percutaneous biopsy. CONCLUSION Benign breast changes can be definitively distinguished from malignant lesions through the selective use of avail- able diagnostic investigations and interdisciplinary collaboration. When lesions of uncertain malignant potential are found (B3 in the biopsy classification), complete excision is indicated. Prospective studies on the early diagnosis of breast cancer in lesions carrying a risk of malignancy are desirable.
Collapse
Affiliation(s)
- Angrit Stachs
- Department of Obstetrics and Gynecology, University of Rostock
| | | | | | | |
Collapse
|
9
|
Banuelos J, Esquer-Garrigos Z, Sohail MR, Abu-Ghname A, VanBuren WM, Tran NV, Nguyen MDT, Hesley GK, Asaad M, Sharaf B. Diagnosis of Infectious Fluid Collections in Implant-Based Breast Reconstruction: The Role of Ultrasound. JOURNAL OF BREAST IMAGING 2019; 1:310-315. [PMID: 38424805 DOI: 10.1093/jbi/wbz060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/15/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Implant-based breast reconstruction after mastectomy remains the most common reconstructive modality worldwide. Infection is a frequent complication that negatively affects the reconstructive outcome and increases health-care costs. The aim of this study is to evaluate the accuracy of ultrasonography in identifying fluid collections in patients with breast implant infection. METHODS After receiving institutional review board approval, a retrospective chart review was performed on patients who presented with breast implant infection after breast reconstruction, during the period 2009-2017. To estimate the sensitivity and specificity of ultrasound (US) in detecting fluid collections, only patients with US evaluation and surgery during the same admission were included. RESULTS In total, 64 patients with 64 infected implants met the inclusion criteria. Infected devices included 44 (69%) tissue expanders, and 20 (31%) implants, of which 40 (62%) were placed in the subpectoral and 24 (38%) prepectoral positions. Periprosthetic fluid was identified by US preoperatively in 45 (70%) of the patients, and a fluid collection was found in 61 (95%) of the patients during surgery. Sensitivity and specificity of US were 74% and 100%, respectively. Inaccurate US results were more likely in patients with silicone implants than patients with saline expander implants. CONCLUSION Caution should be exercised in interpreting negative US findings in patients with silicone implants in the setting of infection. Other imaging modalities should be explored if US results are negative in cases with high clinical suspicion.
Collapse
Affiliation(s)
| | | | | | | | | | - Nho V Tran
- Mayo Clinic, Department of Surgery, Rochester, MN
| | | | | | - Malke Asaad
- Mayo Clinic, Department of Surgery, Rochester, MN
| | - Basel Sharaf
- Mayo Clinic, Department of Surgery, Rochester, MN
| |
Collapse
|
10
|
Chen C, Luo LB, Gao D, Qu R, Guo YM, Huo JL, Su YY. Surgical drainage of lactational breast abscess with ultrasound-guided Encor vacuum-assisted breast biopsy system. Breast J 2019; 25:889-897. [PMID: 31148346 PMCID: PMC6851758 DOI: 10.1111/tbj.13350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 12/03/2022]
Abstract
Lactational breast abscess is a serious complication of mastitis and commonly diagnosed in breast‐feeding women. The traditional drainage of breast abscess was often performed with incisive technique which may result in prolonged healing time, regular dressings, dressing pain, interfering with breastfeeding and unsatisfactory cosmetic outcome. As minimal invasive alternatives to incisive drainage, needle aspiration or percutaneous catheter placement cannot completely replace incisive drainage for the inability to treat large, multiloculated or chronic abscess. Vacuum‐assisted breast biopsy system (VABB) has been successfully applied in the treatment of benign breast diseases with satisfactory cosmetic outcomes. Among VABB devices, EnCor system has some distinctive features that make it an appropriate candidate for the treatment of lactational breast abscesses. In this study, for the first time, we investigated the feasibility, efficacy, and cosmetic results of surgical drainage of lactational breast abscess with US‐guided Encor VABB system. Our data suggests this procedure could serve as a promising alternative for women with lactational breast abscess who require incisive intervention with high cure rate, relatively short healing time, low recurrence rate, few complications, satisfactory cosmetics outcome and without interfering with breastfeeding.
Collapse
Affiliation(s)
- Chen Chen
- Breast and Thyroid Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Li-Bo Luo
- Breast and Thyroid Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Dan Gao
- Department of Ultrasound, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Rui Qu
- Breast and Thyroid Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - You-Ming Guo
- Breast and Thyroid Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Jin-Long Huo
- Breast and Thyroid Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Ying-Ying Su
- Breast and Thyroid Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| |
Collapse
|
11
|
Porembka JH, Compton L, Omar L, Sharma P, Clark H, Ahn R, Ganti R, Xi Y, Metzger J, Leyendecker JR. Breast ultrasound utilization in a safety net emergency department. Emerg Radiol 2018; 26:123-131. [PMID: 30377859 DOI: 10.1007/s10140-018-1651-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/22/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study is to (1) assess the diagnostic yield of ultrasounds performed in the emergency department for suspected breast abscess and determine the rates of reimaging, discordance, and emergent intervention in a large, busy safety net hospital and (2) determine clinical factors significantly associated with abscess as a way to improve patient selection for emergent breast ultrasounds. METHODS A total of 581 consecutive breast ultrasounds performed in the emergency department for suspected abscess over 15 months were retrospectively reviewed for imaging, demographics, laboratory data, and physical exam findings. Breast abscess was confirmed by combining imaging, clinical, and laboratory data. Linear logistic regression analysis estimated the likelihood of abscess, and the cross-validated area under the receiver operating characteristic curve (AUC) evaluated diagnostic performance. RESULTS Final diagnoses included abscess (153/581, 26%), cancer (29/581, 5%), granulomatous mastitis (41/581, 7%), normal (120/581, 21%), and other/indeterminate (238/581, 41%). Factors associated with abscess included induration, fluctuance, erythema, drainage, smoking, diabetes, and Black race. Based on these factors, the AUC of the characteristics predictive of abscess was 0.77 (CI, 0.72-0.81). Six breast cancers were not diagnosed on ultrasound. 40% of ultrasounds (231/581) were considered incomplete/inadequate. CONCLUSION 74% (428/581) of emergent breast ultrasounds in our population were negative for abscess, while 21% (6/29) of cancers were not diagnosed, and 40% (231/581) of exams were incomplete/inadequate. Patient selection for emergent ultrasounds can be improved, allowing patients with a low likelihood of abscess to be imaged in a more optimal setting.
Collapse
Affiliation(s)
- Jessica H Porembka
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard MC 8896, Dallas, TX, 75390-8896, USA. .,Parkland Health and Hospital System, 5201 Harry Hines Blvd., Dallas, 75235, TX, USA.
| | - Lindsay Compton
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard MC 8896, Dallas, TX, 75390-8896, USA.,Parkland Health and Hospital System, 5201 Harry Hines Blvd., Dallas, 75235, TX, USA
| | - Lena Omar
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard MC 8896, Dallas, TX, 75390-8896, USA.,Parkland Health and Hospital System, 5201 Harry Hines Blvd., Dallas, 75235, TX, USA
| | - Pooja Sharma
- Solis Mammography, 15601 Dallas Parkway, Suite 500, Addison, TX, 75001, USA
| | - Haley Clark
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard MC 8896, Dallas, TX, 75390-8896, USA.,Parkland Health and Hospital System, 5201 Harry Hines Blvd., Dallas, 75235, TX, USA
| | - Richard Ahn
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard MC 8896, Dallas, TX, 75390-8896, USA.,Parkland Health and Hospital System, 5201 Harry Hines Blvd., Dallas, 75235, TX, USA
| | - Ramapriya Ganti
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard MC 8896, Dallas, TX, 75390-8896, USA.,Parkland Health and Hospital System, 5201 Harry Hines Blvd., Dallas, 75235, TX, USA
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard MC 8896, Dallas, TX, 75390-8896, USA
| | - Jeffery Metzger
- Parkland Health and Hospital System, 5201 Harry Hines Blvd., Dallas, 75235, TX, USA.,Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8579, USA
| | - John R Leyendecker
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard MC 8896, Dallas, TX, 75390-8896, USA
| |
Collapse
|
12
|
Boakes E, Woods A, Johnson N, Kadoglou N. Breast Infection: A Review of Diagnosis and Management Practices. Eur J Breast Health 2018; 14:136-143. [PMID: 30123878 DOI: 10.5152/ejbh.2018.3871] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/08/2018] [Indexed: 11/22/2022]
Abstract
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.
Collapse
Affiliation(s)
- Eve Boakes
- Department of General Surgery, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, London
| | - Amy Woods
- Department of Medicine, Croydon University Hospital, Croydon, London
| | - Natalie Johnson
- Department of General Surgery, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, London
| | - Naim Kadoglou
- Department of General Surgery, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, London
| |
Collapse
|
13
|
Agarwal MD, Venkataraman S, Slanetz PJ. Infections in the Breast-Common Imaging Presentations and Mimics. Semin Roentgenol 2017; 52:101-107. [PMID: 28606307 DOI: 10.1053/j.ro.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Monica D Agarwal
- Breast Imaging Section, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Shambhavi Venkataraman
- Breast Imaging Section, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Priscilla J Slanetz
- Breast Imaging Section, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
| |
Collapse
|
14
|
Debord MP, Poirier E, Delgado H, Charlot M, Colin C, Raudrant D, Golfier F, Dupuis O. Abcès du sein lactant : et si on ne les opérait plus ? ACTA ACUST UNITED AC 2016; 45:307-14. [DOI: 10.1016/j.jgyn.2015.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 03/12/2015] [Accepted: 04/01/2015] [Indexed: 11/27/2022]
|
15
|
|
16
|
Lam E, Chan T, Wiseman SM. Breast abscess: evidence based management recommendations. Expert Rev Anti Infect Ther 2014; 12:753-62. [PMID: 24791941 DOI: 10.1586/14787210.2014.913982] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Literature review was carried out and studies reporting on treatment of breast abscesses were critically appraised for quality and their level of evidence using the Strength of Recommendation Taxonomy guidelines, and key recommendations were summarized. Needle aspiration either with or without ultrasound guidance should be employed as first line treatment of breast abscesses. This approach has the potential benefits of: superior cosmesis, shorter healing time, and avoidance of general anaesthesia. Multiple aspiration sessions may be required for cure. Ultrasound-guided percutaneous catheter placement may be considered as an alternative approach for treatment of larger abscesses (>3 cm). Surgical incision and drainage should be considered for first line therapy in large (>5 cm), multiloculated, or long standing abscesses, or if percutaneous drainage is unsuccessful. All patients should be treated concurrently with antibiotics. Patients with recurrent subareolar abscesses and fistulas should be referred for consideration of surgical treatment.
Collapse
Affiliation(s)
- Elaine Lam
- Department of Surgery, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | | | | |
Collapse
|