IS case 468: Left axillary abscess

Wade Hedegard, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-08-30

History

Patient is a 53-year-old female presenting with general fatigue and a mass in the left axilla, increasing in size over the past one month.

Findings

Tangential mammographic view demonstrated a soft tissue mass high up in the left axilla. Focused ultrasound of the left axilla demonstrated a complex heterogeneous mass with irregular borders. There were two adjacent/involved hypoechoic lymph nodes. There was not a normal fatty hilum. Ultrasound-guided biopsy was performed.

Diagnosis

Left axillary abscess

Discussion

Breast and/or axillary abscesses are localized collections of pus within the subcutaneous tissues. Breast abscesses are categorized as lactational or non-lactational. Lactational mastitis and abscesses are more common. Non-lactational mastitis and/or abscesses are further subcategorized as central/retroareolar or peripheral. Peripheral breast abscesses occur primarily in immunosuppressed/diabetic patients. Heavy smokers are also at increased risk of breast abscess. The clinical and imaging findings of breast abscess can be nonspecific. Therefore, biopsy and histologic evaluation is often essential. The most important differential diagnosis to always consider is inflammatory breast carcinoma. Both conditions can present as a red, inflamed breast. Fever may or may not be present. The role of ultrasound in the work-up of an inflamed breast is critical. It is used to evaluate for any solid lesion or for the presence of a focal fluid collection. If either of these conditions is present, ultrasound can then be used to guide fine needle aspiration or core biopsy. Non-lactational breast abscesses are treated with the combination of oral antibiotics and aspiration. Aspiration should be repeated every few days until no pus is present. Surgical drainage is not usually required.

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. Versluijs-Ossewaarde FN, Roumen RM, Goris RJ. Subareolar breast abscesses: characteristics and results of surgical treatment. Breast J. 2005 May-Jun;11(3):179-82. PMID: 15871702

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