Inflammatory Breast Disease Flashcards
What is mastitis?
Inflammation of the breast tissue both acute or chronic
Most common cause infection typically S.Aureus but can occasionally be granulomatous
What are the two classification of mastitis?
Lactational mastitis (more common)
Non-lactational mastitis
What is lactational mastitis?
1/3 or breastfeeding women usually during first 3 months or during weaning
Associated with cracked nipples and milk stasis - often from poor feeding techniques and more common in first child
What is non-lactational mastitis?
Can occur in women with other condition such as: duct ectasia, peri-ductal mastitis
Smoking is a important risk factor
What are the clinical feature of mastitis?
Tenderness, swelling and erthyema over area of infection - important to determine that no abscess has formed.
What is the management of mastitis?
Antibiotic therapy and simple analgesics
Continue milk drainage or breast feeding
If persistent or multiple areas of infection the dopamine agonists can be considered
How may breast abscess present?
Tender fluctuant and erythematous masses with a puncutum potentially present.
Associated symptoms - fever, lethargy
What is the management of breast abscess?
Ultrasound if doubt about diagnosis
Empirical antibiotics and US-guided needle therapeutic aspiration.
More advanced may require incision and drainage under local anaesthetic.
What is a complication of drainage of a non-lactational abscess?
Formation of a mammary duct fistula - managed surgically with fistulectomy and antibiotics
Can often recur
What are breast cysts?
Epithelial lined fluid-filled cavities which form when lobules become distended due to blockage usually in the perimenopausal age group.
Peak age 35-55 yrs
What are the clinical features of breast cysts?
Singularity or multiple lumps
Affects one or both breasts
Distinct smooth masses which may be tender
What investigations can be done for breast cysts and what is seen?
Ultrasound - may be aspirated - if no blood present or lump disappears then not cancer - but if not then cytology must be done
Mammography - halo shape
What is the management of breast cysts?
No further management and self-resolve - high risk of recurrence
Analgesia - cyclical pain treated with high dose gamolenic acid(GLA) or danazol
Larger cysts may be aspirated for aesthetic or pt reassurance
What are the complications of breast cysts?
2% of patients with have carcinoma at presentation alongside cyst
Higher risk of developing breast cancer
Fibroadenosis - multiple small cysts and fibrotic areas - often benign associated with tenderness and asymmetry - can mask malignancy
What is mammary duct ectasia?
Dilation and shortening sometimes calcification of the major lactiferous ducts - common in peri-menopausal women
What are the clinical features of mammary duct ectasia?
Green/yellow discharge
Palpable mass
Nipple retraction
Mastalgia
What investigations could be done for mammary duct ectasia?
Mammography
Biopsy - typically multiple plasma cells on histology
What is the management of mammary duct ectasia?
Conservative management unless cannot exclude malignancy.
Unremitting nipple discharge can be treated with duct excision
What is fat necrosis and what are its causes?
Acute inflammatory response in the breast leading to ischaemic necrosis of the fat nodules.
Causes are:
- Trauma
- previous surgical or radiological intervention
What are the clinical feature of fat necrosis?
Usually asymptomatic with a lump
Less commonly can preset with fluid discharge, skin dimpling, pain and nipple inversion
Inflammatory response can persist causing chronic fibrotic changes - solid irregular lump
What investigations should be done in fat necrosis?
Ultrasound - hyperechoic mass
Mammography- may mimic malignancy so cor biopsy should be taken to rule it out
What is the management of fat necrosis?
Self-limiting
Analgesia and reassurance
What is periductal mastitis?
Inflammation of due to infection of the subareolar ducts
May be present like duct ectasia
Pus discharge from nipple and mastalgia
