Breast Concerns Flashcards
evaluation of a breast mass in a woman >30 years should be with a
both a diagnostic mammogram and breast ultrasound.
mammogram magnifies views of focal area of concern
ultrasound will determine if mass is cystic or solid.
can a clinical exam differentiate between cyst or mass?
no it can’t
definitive diagnosis of a breast mass is with
tissue sampling with a fine needle aspiration,
core needle biopsy with or without stereotactic
ultrasound guidance or excisional biopsy
tissue sampling for solid breast lesion
core needle biopsy
tissue sampling modality for ultrasound confirmed cystic lesion?
fine needle aspiration
when to get excisional biopsy of a breast mass?
core needle biopsy is non diagnostic when biopsy and imaging studies do not concur.
imaging modality for woman <30 yrs
breast ultrasound because of the increased density of breast tissue. also better in pregnant pts because no radiation exposure.
plugged breast milk duct clinical presentation (post partum)
plugged milk ducts have breast pain and tenderness and palpable masses with no signs of infection.
Results from poor feeding technique, decrease in feeding, inadequate emptying and stasis can lead to breast engorgement (breast tissue distension) and subsequent blockage of milk ducts.
what causes blocked breast milk duct?
Results from poor feeding technique, decrease in feeding, inadequate emptying and stasis can lead to breast engorgement (breast tissue distension) and subsequent blockage of milk ducts.
Treatment of blocked breast milk duct is to:
optimize feeding technique, continued breast feeding, symptomatic relief with (warm compresses, manual massage, NSAIDS)
galactocele presentation
subareolar, mobile, well circumscribed, nontender mass, no fever
post partum pt who presents with tenderness/ erhythema + fever
mastitis
post partum breast feeding mother presents with symptoms of tenderness, erythma and fever with fluctuant mass
breast abscess
symptoms of nipple injury:
abrasion, bruising, cracking or blistering from poor latch
Common problems from lactation
Galactocele is a
large milk retained cyst due to a blocked milk duct. Galactoceles are painless and resolve and if they persist, U/S with or without aspiration may be used to differentiate it from malignancy.
inflammatory breast cancer
palapable mass, with painful enlarged pruritic breast with skin thickening (peau’d orange appearance. Seen more in post menopausal women and can present as mastitis that doens’t resolve after abx.
due to rapid metastasis, axillary lymph nodes are also palpable.
Need a diagnostic mammogram and core needle biopsy.
lactational mastitis is
complication of engorgement and plugged milk ducts. Pts present with fever, localized breast pain and erythema but NO mass.
Lactational mastitis doesn’t need imaging.
lactational mastitis tx
NSAIDS, contineud breast feeding and treat with (dicloxacillin, cephlexin) that provides coverage agaisnt Staph aureus.
Untreated lactational mastitis can progress to abscess.
