Abscesses of the breast: US-guided serial percutaneous aspiration and local antibiotic therapy after unsuccessful systemic antibiotic therapy

Imperiale, A.; Zandrino, F.; Calabrese, Massimo; Parodi, Giancarlo; Massa, T.

doi:10.1080/028418501127346666

Cited by 27 publications

(32 citation statements)

References 17 publications

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“…According to recently published 2011 algorithm, a trial of ultrasound guided drainage is recommended for all fluid collections suggesting an abscess, regardless of size, which occur during the breastfeeding period, are caused by S. aureus, and lack a multiloculated structure. The greatest success is achieved with abscesses that are \3 cm in diameter [3,4]. Abscesses that are multiloculated or larger than 3 cm in diameter may fail ultrasound-guided drainage; thus, in such instances, early surgical evaluation for incision and drainage is strongly recommended [4].…”

Section: Discussionmentioning

confidence: 99%

Emergency management of puerperal breast abscess

Chauhan

Polen

2012

Intern Emerg Med

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A 38-year-old woman, who was 1 month postpartum, presented with left breast pain. The patient reported a 5-day history of stabbing left breast pain, erythema, and tenderness. She had been breast feeding and pumping breast milk without difficulty, but recently noted blood, mucous, and purulent material within the pumped milk. The patient denied fevers, chills, breast trauma, a palpable mass, or right breast abnormalities. Ultrasound of the left breast demonstrated a 4.7 9 2.1 cm complex fluid collection with associated skin thickening, consistent with left breast cellulitis, mastitis, and a breast abscess (Fig. 1). Surgical consultation was obtained, and a trial of ultrasound-guided aspiration of the left breast abscess was completed (Fig. 2) that yielded 12 ml of purulent fluid. Aspirated samples were evaluated by microbiology with cultures positive for methicillin-resistant Staphylococcus aureus. Trimethoprim and sulfamethoxazole were initiated for 7 days. Repeat ultrasound of the left breast demonstrated complete resolution of the left breast abscess (Fig. 3). On return visit, the patient reported decreased pain, swelling, and drainage from the left breast, and has subsequently been able to resume left breast feeding and pumping. DiscussionCellulitis, mastitis, and breast abscesses exist along a continuum, with breast abscesses occurring in 5-11 % of lactating women with infectious mastitis [1]. Most breast abscesses develop secondarily to skin contamination with S. aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Peptostreptococcus, or Bacteroides [1]. Common symptoms of breast abscesses, as illustrated by this case, include breast pain, erythema, tenderness, and increased breast temperature with or without fever or a palpable breast mass. Ultrasonography is the imaging modality of choice due to its availability, painless use, ability to conduct repeat examinations during the course of therapy, and its ability to guide percutaneous drainage [2]. In cases of confirmed breast abscesses, ultrasonography usually demonstrates a multiloculated hypoechoic fluid collection of variable shape and size with a thickened periphery and increased vascularity. According to recently published 2011 algorithm, a trial of ultrasound guided drainage is recommended for all fluid collections suggesting an abscess, regardless of size, which occur during the breastfeeding period, are caused by S. aureus, and lack a multiloculated structure. The greatest success is achieved with abscesses that are \3 cm in diameter [3,4]. Abscesses that are multiloculated or larger than 3 cm in diameter may fail ultrasound-guided drainage; thus, in such instances, early surgical evaluation for incision and drainage is strongly recommended [4]. In addition to ultrasound-guided drainage, all suspected breast abscesses should be managed with antibiotics including cloxacillin 500 mg four times daily, clindamycin 300 mg four times daily, erythromycin 500 mg three times daily, or cefazolin 500 mg four times daily for a total of 7-10 days [4,5]. B...

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Section: Discussionmentioning

confidence: 99%

Emergency management of puerperal breast abscess

Chauhan

Polen

2012

Intern Emerg Med

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“…As far as we know, Karstrup, et al [7] first reported the successful use of this technique in 1990, soon followed by other investigators. More recently, Imperiale, et al [2] resurrected the local instillation of antibiotics (40-160 mg of gentamicin) after sonographically-guided percutaneous aspiration in 26 patients with non-puerperal abscesses in whom systemic antibiotics failed, with only one failure requiring surgical drainage. Karstrup, et al.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound-guided drainage has been described in smaller series as a treatment for breast abscesses, the treatment for which has traditionally been surgery or even less frequently, punctures without imaging guidance [1][2][3][4]. In some institutions, the standard treatment still remains early incision under general anaesthesia combined with drainage tube insertion [5].…”

Section: Introductionmentioning

confidence: 99%

Clinical profile and methodology in the management of inflammatory benign breast lesions

Munakomi¹,

Adhikary²

2014

Cureus

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There is a high incidence of mammary infections among females who attend the emergency department or surgery outpatient department. Acute bacterial mastitis either resolves under antibiotic therapy or evolves towards a pyogenic abscess. Traditional treatment of breast abscesses is by surgical incision, digital disruption of septa, evacuation of contents with occasional placement of surgical drains, and administration of systemic antibiotics. This strategy often requires general anaesthesia, may leave unpleasant scars, is more expensive than aspiration, requires regular postoperative dressing changes, and interferes with lactation. Overall, about 10-38% of abscesses recur and require additional surgical drainage. Needle aspiration of the pus in breast abscesses has been reported both with and without ultrasound guidance. It causes less scarring, does not affect breast-feeding, nor does it require general anaesthesia or hospitalization. It is in fact a less expensive procedure than surgery. This study was applied to all patients with mammary infections. Ultrasound-guided drainage was done for abscesses of limited size. If the abscesses were bigger or when image-guided aspiration was not effective, they were considered for operative intervention.

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“…The standard management of lactational breast abscess used to be surgical incision and drainage, but recurrent aspiration has been recommended as a preferable alternative for many women1. This has been verified in studies both with2, 3 and without4, 5 the use of ultrasonographic guidance. The benefits of outpatient treatment are considerable for both the patient and the hospital.…”

Section: Introductionmentioning

confidence: 99%