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Age: 23

Sex: Female

Indication: Left breast pain, redness

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Case #22


Findings

  • Irregular, hypoechoic, heterogeneous retroareolar mass with angular margins and posterior acoustic enhancement measuring 3.3 x 3.2 x 3.2 cm
  • Overlying skin thickening and surrounding subcutaneous edema
  • No internal vascularity


Diagnosis

Breast abscess

Sample Report

Irregular hypoechoic left retroareolar breast mass measuring 3.3 x 3.2 x 3.2 cm with overlying skin thickening and surrounding subcutaneous edema, which is concerning for a left breast abscess and surrounding mastitis/cellulitis. Recommend surgical evaluation. Repeat breast ultrasound should be considered if there is concern for incomplete resolution following treatment.


Discussion

  • One useful way to approach breast abscesses is to separate them by whether they are puerperal (related to breastfeeding) or nonpuerperal and central (retroareolar) or peripheral
    • The most common type of breast abscesses are central nonpuerperal, which occur most commonly in young smokers and have a high risk for recurrence
    • Peripheral nonpuerperal abscesses are more frequent in middle-age to older women, are associated with various chronic medical conditions, and have a much lower risk for recurrence
    • Puerperal abscesses also typically respond well to treatment and have a low recurrence rate
  • Ultrasound is the preferred imaging modality in working up suspected mastitis, though mammography should also be obtained to more confidently exclude malignancy in women over 30 who are not peripartum and should also be considered in atypical cases in all women
  • When indicated, mammography is typically delayed until symptom improvement to improve patient tolerance of the exam
  • Inflammatory carcinoma is a feared abscess mimic and should be excluded by biopsy in patients who do not respond as expected to antibiotics
  • Assigning a BI-RADS category can be confusing in these patients, but one proposed approach is to assign suspected abscesses a BI-RADS category 4A, which carries a low suspicion for malignancy and a recommendation for tissue sampling (aspiration in the case of abscess)



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