Inflammatory and infective breast disease

Question 1

What is mastitis?

Answer 1

Inflammation of the breast tissue

Question 2

How is mastitis classified?

Answer 2

By lactation status:
- Lactational mastitis
- Non-lactational mastitis

Question 3

How common is lactational mastitis?

Answer 3

1/3 breastfeeding women

Question 4

When does lactational mastitis present?

Answer 4

During the first 3 months of breastfeeding or during weening

Question 5

What are some causative organisms in lactational mastitis?

Answer 5

Staph aureus
Strep pyogenes

Question 6

What are some risk factors for non-lactational mastitis

Answer 6

Tobacco smoking (Sub-areolar duct wall damage pre-disposes to bacterial infection)

Question 7

What are some common co-morbid conditions with non-lactational mastitis?

Answer 7

Duct ectasia
Peri-ductal mastitis

Question 8

What are some causative organisms of non-lactational mastitis?

Answer 8

Mixed organisms
Anaerobes

Question 9

How does mastitis usually present?

Answer 9

• Induration
• Tenderness
• Swelling or induration
• Eythema
• Fever

Question 10

How is mastitis diagnosed?

Answer 10

Clinical diagnosis

Question 11

How is mastitis managed?

Answer 11

Flucloxacillin 500mg every 6 hours
or Augmentin 625mg every 8 hours
For 7 days
Examination every 3 days
Continued milk drainage or feeding in lactational mastitis

Question 12

What is a possible complication of mastitis?

Answer 12

Breast abscess

Question 13

What is a breast abscess?

Answer 13

A collection of pus within the breast lined granulation tissue

Question 14

What is the most common cause of breast abscess?

Answer 14

As a complication of acute mastitis

Question 15

How does a breast abscess present?

Answer 15

Flocculent sometimes-bulging mass, usually located in the central area of mastitis
Fever
Lethargy

Question 16

How is a breast abscess diagnosed?

Answer 16

USS
Aspiration and microbiological analysisH

Question 17

How is a breast abscess managed?

Answer 17

Abe until all cellulitis has cleared
Aspirations may be repeated every 3 days
Surgical drainage if required

Question 18

What are breast cysts?

Answer 18

Epithelial lined fluid-filled cavities, which form whenlobules become distendeddue to blockage, usually in theperimenopausalage group

Question 19

When do breast cysts most commonly form?

Answer 19

during the late reproductive years of a woman’s life

Question 20

How do breast cysts present?

Answer 20

Singular or multiple lumps
Palpable, clearly defined, soft, mobile, smooth
Distinct borders
Tender before menstruation

Question 21

What investigations are required in breast cysts?

Answer 21

USS
Possibly mammography
Aspiration (If required)

Question 22

How will breast cyst show on mammography

Answer 22

Halo shaped lesion

Question 23

How are breast cysts managed?

Answer 23

Usually self-resolve
Larger cysts can be aspirated for aesthetic reasons

Question 24

What is duct ectasia?

Answer 24

Dilatation and shortening of the major lactiferous ducts

Question 25

Who is duct ectasia most common in?

Answer 25

Peri-menopausal women 40% having significant duct dilatation by 70 Smokers

Question 26

Describe the pathophysiology of duct ectasia

Answer 26

- Sub-areolar duct dilation - Periductal inflammation and fibrosis - Scarring and distortion

Question 27

How does duct ectasia present?

Answer 27

Acute episodic inflammatory changes such as: - Pain - Bloody and/or purulent nipple discharge - Fistulation - Nipple retraction and distortion

Question 28

How is duct ectasia diagnosed?

Answer 28

Mammography Biopsy

Question 29

How is duct ectasia shown on mammography?

Answer 29

Dilated, calcified ducts with no other features of malignancy

Question 30

How is duct ectasia managed?

Answer 30

Conservatively Duct excision (If unremitting nipple discharge)

Question 31

What is a possible complication of duct ectasia?

Answer 31

Acute mastitis/abscess

Question 32

what is fat necrosis?

Answer 32

A common condition caused by an acute inflammatory response in the breast, leading to ischaemic necrosis of fat lobules

Question 33

What are some causes of fat necrosis?

Answer 33

Blunt breast trauma (E.g. Seatbelt injury) Surgery Radiology Warfarin therapy

Question 34

Describe the pathophysiology of fat necrosis

Answer 34

1. Damage and disruption of adipocytes 2. Infiltration by acute inflammatory cells 3. Aggregation of ‘foamy’ macrophages 4. Subsequent fibrosis and scarring

Question 35

How does fat necrosis present?

Answer 35

- Usually asymptomatic or presenting as a lump, however less commonly can present with fluid discharge, skin dimpling, pain and nipple inversion - The acute inflammatory response can persist, causing a chronic fibrotic change that can subsequently develop into a solid irregular lump

Question 36

How is fat necrosis diagnosed?

Answer 36

History positive of trauma Hyperechoic mass on USS Mammography and core biopsy if suspicious

Question 37

How is fat necrosis managed?

Answer 37

Self limiting Analgesia and assurance