IS Case 431: Puerperal breast abscess

Sara Ann Majewski, MD

University of Rochester


Imaging Sciences URMC 2010
Publication Date: 2010-08-27

History

A 24-year-old nursing female presented with painful right breast lump as well as recent fever and chills.

Findings

Abscesses typically present as ill-defined fluid collections with heterogeneous echogenicity centrally.

Diagnosis

Puerperal breast abscess

Discussion

Puerperal breast infection is common during breast-feeding. The nipple-areola epithelium is interrupted by retrograde spread of organisms from nursing baby's nose and throat. Milk stasis provides a culture medium for organisms. The most common organisms are Staph aureus and Streptococcus. S aureus frequently causes abscesses and can be focal and invasive even at onset. Streptococcus usually only causes abscess in advanced stages. If mastitis is caught early and treated with antibiotics, abscess can be avoided.

On mammography, abscesses may appear as ill-defined masses. Ultrasound is the most important modality for diagnosing abscess. Ultrasound demonstrates irregular, hypoechoic or anechoic masses, with or without fluid-debris levels and posterior acoustic enhancement.

Treatment of puerperal abscess involves oral antibiotics in addition to surgical incision and drainage or ultrasound-guided drainage.

References

  1. Christensen AF, Al-Suliman N, Nielsen KR, et al. Ultrasound-guided drainage of breast abscesses: results in 151 patients. Br J Radiol. 2005 Mar;78(927):186-8. PMID: 15730981
  2. Sabate JM, Clotet M, Torrubia S, et al. Radiologic evaluation of breast disorders related to pregnancy and lactation. Radiographics. 2007 Oct;27 Suppl 1:S101-24. PMID: 18180221

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