Inflammatory breast disease: The radiologist's role

Abstract

Mastitis is the inflammation of breast tissue. From a pathophysiological point of view, mastitis reflects a variety of underlying etiologies. It can be due to non-infectious inflammation, infection (generally of bacterial origin) but can also be caused by inflammation resulting from malignant tumor growth. Mastitis always manifests clinically by three cardinal signs of inflammation, which are redness, heat and pain. Breast specialists examining women with mastitis should proceed as follows: first, it is important to distinguish between cancer-related and non-cancer-related breast inflammation, since their clinical presentation can be misleading. Cancer-related mastitis reflecting the presence of aggressive cancer is less commonly observed than other forms of mastitis but its diagnosis, which can sometimes be difficult, needs to be made, or excluded, without delay. Once cancer-related mastitis has been excluded, the causes of inflammation should be elucidated to enable rapid treatment and patient recovery.

Sonographic features of inflammatory conditions of the breast

“…In inflammatory breast carcinoma, ultrasound will demonstrate dermal thickening and oedema, and often small anechoic areas may be seen within the dermis representing dilated dermal lymphatics . Ultrasound may also demonstrate an increase in the echogenicity of the breast parenchyma related to oedema of the tissues and thickened Coopers ligaments and will often also reveal multiple suspicious hypoechoic tumour masses with posterior acoustic shadowing and irregular borders (Figures and ).…”

“…Breast inflammation is usually associated with oedema and thickening of the skin, and ultrasound provides a very useful means of assessing skin thickness by comparing the measurements on the affected breast with those of the skin on the contralateral breast . Subcutaneous oedema is evidenced on ultrasound by the presence of a diffuse increase in the thickness and echogenicity of the subcutaneous tissues (Figure ).…”

“…Infective mastitis can also be the result of relatively rare infections such as Nocardia, a bacteria usually found in soil and water, Pseudomonas aeruginosa and fungi …”

“…Non‐infective causes of mastitis include duct ectasia or periductal mastitis, granulomatous mastitis and fat necrosis. The scenario of a patient with mastitis who does not respond to antibiotic therapy should raise suspicions as to the possibility of inflammatory breast carcinoma …”

Comparison Of The Restoration Of Breast Feeding After Percutaneous Aspiration Vs Incision And Drainage For Management Of Breast Abscess

“…Unfortunately, this type of treatment can lead to postoperative complications like unsightly scar formation and had a negative effect for the suckling, resulting in giving-up of breast-feeding 5 . Ultrasound-guided (USG) percutaneous needle aspiration, have been considered useful for fluid aspiration from breast cysts of less than 3 centimeters 6 . Ultrasound is a useful tool in diagnosis of breast abscesses and guiding needle placement during aspiration.…”