14 - Breast Disorders

Question 1

Difference of mastitis and abscess in terms of appearance in ultrasound

Answer 1

Mastitis: Hypoechoic fluid surrounding subcutaneous fat lobules without a discrete fluid collection
Abscess: Hypoechoic fluid collection WITHIN the tissue in the ABSENCE of vascular signals

Question 2

Most common pathogen in puerperal mastitis?

Answer 2

Staphylococcus aureus

Question 3

TRUE OR FALSE: When treating puerperal mastitis, breastfeeding is advised to be discontinued.

Answer 3

FALSE
There is no need to interrupt breastfeeding; treatment usually requires analgesia, breast emptying and antibiotics with antistaphylococcal penicillins or cephalosporins

Question 4

Treatment for breast abscess

Answer 4

US-guided drainage

Question 5

Remarks for Hidradenitis Suppurativa

Answer 5

• Presents with recurrent multiple cutaneous abscess, sinus tracts and scarring of the breast folds, axillae, and groin and perineum
• Chronic inflammatory disease involving the obstruction of sweat glands and polymicrobial colonization, usually with Staphylococcus and Streptococcus
• Initial treatment includes incision and drainage

Question 6

Remarks for Mondor’s Disease

Answer 6

• A benign, self-limited superficial thrombophlebitis usually seen in young women of childbearing age
• Patients present with a painful palpable cord or mass in the superficial tissue of the breast, most commonly in LOWER QUADRANTS

Question 7

Treatment for Mondor’s Disease

Answer 7

1. NSAIDs
2. LMWH

Question 8

Physical signs that should prompt surgical referral

Answer 8

PALPABLE MASS WITH/WITHOUT THE FOLLOWING:
1. Lymphadenopathy
2. Skin ulceration
3. Mass fixation to the chest wall
4. Fixed axillary nodes
5. Presence of ipsilateral arm edema

Question 9

Remarks on breast implant infections

Answer 9

• Most common pathogen: S. aureus
• Treatment if admitted: vancomycin + gentamycin
• If for outpatient: Tetracycline and doxycycline