breast infections: a case based...
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11/09/2012
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Derek Muradali
Breast Infections: A case based approach
Imaging features of breast infections
• Abscess: solitary, multiple
• Phlegmon
• Infiltrative
• Ductal involvement
• Skin
• Internal echoes
Imaging features: Complex cyst (non specific)
• Fluid debris level
Imaging features: Complex cyst (non specific)
Imaging features: Complex cyst (non specific)
• Septations • Walls
Imaging features: Complex cyst (non specific)
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Abscess : Complex cyst (specific)
• Air
Abscess : Complex cyst (specific)
• Air
Abscess : Complex cyst (specific)
• Air • Inflammation/ infection
Abscess : echogenic fat
• May see clinical response first with fat echogenicity
Abscess : echogenic fat Abscess: Debris
• Avascular
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Abscess: posterior extension
• Often penetrates deep in the breast
Abscess: extends to skin
• Pressure release
• Small cysts in wall produce echogenic foci
Mimicker: pseudo-air artifact
• Dirty shadowing
Mimicker: pseudo-air artifact
Abscess Free silicone
• Dirty shadowing
Mimicker: pseudo-air artifact
Abscess Tissue expander/ implant
• Focal zone artifact
Mimicker: pseudo fluid debris level
Fat necrosis
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Doppler: Abscess
Flow: peripheral, surrounding tissue Flow: peripheral, surrounding tissue, septae
Doppler: Abscess
Phlegmon
Flow: central Flow: central
Phlegmon
Phlegmon
Flow: central and peripheral
Phlegmon Vs Abscess
Assists with drainage
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Phlegmon – minimal vascularity Infiltrative
• Infiltrative appearance
Mimicker: DCIS Ductal involvement
Ductal involvement Ductal involvementNipple
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Ductal involvement
Nipple Nipple
DuctDuct
Male
Skin
Hypoechoic thickening
Skin
Anechoic collection7 months
Skin
Collection with internal echoes
Skin
Penetrate into posterior dermis
Skin
Penetrate into breast tissueMale
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Skin
Infected sebaceous cyst
Treatment
• Antibiotics
• Recurrent aspirations
• Drainage catheter