Name
BREAST ABSCESS
DESCRIPTION
DETAIL
CAUSES: β’ Puerperal abscesses - blocked lactiferous duct β’ Subareolar abscess - squamous epithelial neoplasm with keratin plugs or ductal extension with associated inflammation β’ Peripheral abscess - stasis of the duct -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Carcinoma (inflammatory) β’ Tuberculosis (may be associated with HIV infection) β’ Actinomycosis β’ Typhoid β’ Sarcoid β’ Syphilis β’ Hydatid cyst β’ Sebaceous cystβ’ Leukocytosis β’ Elevated sedimentation rate β’ Culture and sensitivity of drainage to identify pathogen, usually staphylococci or streptococcus. Non-lactational abscess associated with anaerobic bacteria. IMAGING: β’ Ultrasound β’ Mammogram - cannot exclude carcinoma DIAGNOSTIC PROCEDURES: β’ Aspiration for culture β’ Fine needle aspiration (FNA) not accurate to exclude carcinoma
TYPENOTES
RISK FACTORS: Puerperal mastitis 5-11% go on to abscess, Diabetes, Rheumatoid arthritis, Steroids, Silicone/paraffi n implants, Lumpectomy with radiation, Heavy cigarette smoking, Nipple retractionGENERAL MEASURES: β’ Cold compresses β’ Expression of milk SURGICAL MEASURES: β’ Aspiration possibly under ultrasound guidance β’ Incision and drainage with removal of loculations and biopsy of all non-puerperal abscesses to rule out carcinoma β’ Open all fistulous tracts, especially in nonlactating abscesses DRUG(S) OF CHOICE: . Non-steroidal anti-infl ammatory agents . Erythromycin 250-500 mg qid . First generation, oral cephalosporin . Cephalexin 500 mg bid . Cefaclor 250 mg tid . Amoxicillin-clavulanate (Augmentin) 250 mg tid . Clindamycin 300 mg tid if anaerobes suspected PREVENTION/AVOIDANCE β’ Early treatment of mastitis with milk expression and cold compresses β’ Early treatment with antibiotics POSSIBLE COMPLICATIONS: Fistula EXPECTED COURSE/PROGNOSIS: Good. Complete healing expected in 8 to 10 days, particularly if abscess can be incised and drained.
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
COMPLETE BLOOD COUNT, PUS CULTURE TEST
[BREAST ABSCESS]