Inflammatory breast disease

Question 1

What is mastitis?

Answer 1

inflammation of the breast tissue

Question 2

What is the most common cause of mastitis?

Answer 2

infection- S aureus

Question 3

What are the two types of mastitis?

Answer 3

Lactational mastitis or non lactational mastitis

Question 4

What is lactational mastitis?

Answer 4

present in up to a third of breast feeding women, usually presents in the first 3 months of breast feeding or during weaning, cracked nipples and milk stasis usually due to poor feeding technique

Question 5

What is non-lactational mastitis?

Answer 5

More likely to occur in women with dust ectasia, peri-ductal mastitis, smokers- due to damage to the sub areolar duct walls and predisposes to bacterial infection

Question 6

What are the clinical features of mastitis?

Answer 6

tenderness, swelling, erythema

Question 7

What is the management for mastitis?

Answer 7

antibiotics and analgesia, in lactational mastitis should continue to drain milk and feed

Question 8

What is a breast abscess?

Answer 8

Collection of pus within the breast lined with granulation tissue usually from acute mastitis

Question 9

How do breast abscesses present?

Answer 9

tender fluctuant and erythematous masses, with a puncutum potentially present, fever, lethargy

Question 10

How can breast abscesses be confirmed?

Answer 10

ultrasound

Question 11

How are breast abscesses treated?

Answer 11

antibiotics and ultrasound guided needle aspiration or incision and drainage

Question 12

What can be a complication of drainage of a non-lactational abscess?

Answer 12

mammary duct fistula

Question 13

what is a breast cyst?

Answer 13

cysts are epithelial lined fluid filled cavities which form when lobules become distended due to blockage

Question 14

What group of women are prone to breast cysts?

Answer 14

perimenopausal women

Question 15

What are breast cysts like?

Answer 15

singular or multiple limbs that can affect one or both breasts, smooth masses that may be tender

Question 16

what shape are breast cysts on mammography?

Answer 16

halo shape

Question 17

How can breast cysts be definitively diagnosed?

Answer 17

Ultrasound

Question 18

What should happen to breast cysts if they are persisting, symptomatic or undetermined?

Answer 18

aspiration, if free of blood then is not cancer

Question 19

What is the management for a breast cyst?

Answer 19

no further management and self resolve, large cysts can be aspirated

Question 20

What is a complication of breast cysts?

Answer 20

2% of patients have carcinoma and have greater risk of cancer if do not already have it, fibroadenosis

Question 21

What is mammary duct ectasia?

Answer 21

Duct ecstasia is the dilation and shortening of the major lactiferous ducts, common presentation in peri-menopausal women

Question 22

How does duct ectasia present?

Answer 22

coloured green/yellow nipple discharge and a palpable mass or nipple retraction

Question 23

What investigations should be done for duct ectasia?

Answer 23

mammography by dilated calcified ducts without any other features of malignancy, biopsy will have multiple plasma cells

Question 24

What is the management for duct ectasia?

Answer 24

duct excision if discharge persists

Question 25

What is fat necrosis of the breast?

Answer 25

common condition by acute inflammatory response of the breast causing ischaemic necrosis of fat lobules

Question 26

What is implicated in 40% of fat necrosis of the breast?

Answer 26

Trauma

Question 27

What are the clinical features of fact necrosis of the breast?

Answer 27

asymptomatic but may have a lump, fluid discharge, skin dimpling, pain and nipple inversion, chronic fibrotic changes and then a solid irregular lump

Question 28

What are the investigations done for fat necrosis of the breast?

Answer 28

positive traumatic history and or hyperechoic mass on ultrasound, biopsy to rule out malignancy

Question 29

What is the treatment for fat necrosis of the breast?

Answer 29

analgesia and reassurance