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Li D, Li J, Yuan Y, Zhou J, Xiao Q, Yang T, Li Y, Jiang L, Gao H. Risk factors and prognosis of acute lactation mastitis developing into a breast abscess: A retrospective longitudinal study in China. PLoS One 2022; 17:e0273967. [PMID: 36048839 PMCID: PMC9436116 DOI: 10.1371/journal.pone.0273967] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Breast abscess is developed on the basis of acute mastitis, which will cause damage to the physical and mental health of lactating women and is an important factor affecting the rate of breastfeeding. This study examined the risk factors for mastitis to develop into breast abscess, and analyzed the distribution of pathogenic bacteria, bacterial resistance, and treatment outcome.
Methods
The medical records of 316 cases of mastitis and 219 cases of breast abscess were retrospectively collected. We analyzed the bacterial distribution of mastitis and breast abscess, and compared the differences of bacterial drug resistance. Univariate analysis and binary logistic regression were used to analyze the following aspects: age, primiparity or not, history of breast surgery, body temperature, puerperium or not, onset time, located in the nipple/areolar complexe area or not, history of massage by non-professionals, staphylococcus aureus/methicillin-resistant staphylococcus aureus (MRSA) infection or not, diabetes and white blood cell count.
Results
Of the 535 patients, 203 (37.9%) were positive for staphylococcus aureus. There were 133 (65.5%) cases of methicillin-sensitive staphylococcus aureus (MSSA) and 70 (34.5%) cases of MRSA. Concerning bacterial drug resistance, a statistical analysis showed that MSSA had high resistance rate to penicillin (96.2%), ampicillin (91%), clindamycin (42.9%) and erythromycin (45.9%). MRSA had a high resistance rate to penicillin (100%), ampicillin (98.6%), oxacillin (95.7%), erythromycin (81.4%), clindamycin (80%), and amoxicillin (31.7%). Risk factors for progression of mastitis to breast abscess include a body temperature<38.5°C, a postpartum time ≥ 42 days, an onset time ≥ 2 days, lesions in the nipple/areolar complex area, a history of massage by non-medical staff and bacterial cultures for milk or pus that test positive for staphylococcus aureus or MRSA (P < 0.001).
Conclusions
The most common pathogenic bacteria of mastitis and breast abscess is staphylococcus aureus. There are many risk factors for mastitis to develop into breast abscess. We should take effective measures for its risk factors and select sensitive antibiotics according to the results of bacterial culture to reduce the formation of breast abscess.
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Affiliation(s)
- Daxue Li
- Department of Breast and Thyroid Surgery, Chongqing Health Center for Women and Children (Women and Children’s Hospital of Chongqing Medical University), Chongqing, China
| | - Jiazhen Li
- Department of Medical Ultrasonics, General Hospital of Chonggang, Chongqing, China
| | - Yuan Yuan
- Department of Medical Record, Chongqing Health Center for Women and Children (Women and Children’s Hospital of Chongqing Medical University), Chongqing, China
| | - Jing Zhou
- Department of Breast and Thyroid Surgery, Chongqing Health Center for Women and Children (Women and Children’s Hospital of Chongqing Medical University), Chongqing, China
| | - Qian Xiao
- Department of Breast and Thyroid Surgery, Chongqing Health Center for Women and Children (Women and Children’s Hospital of Chongqing Medical University), Chongqing, China
| | - Ting Yang
- Department of Breast and Thyroid Surgery, Chongqing Health Center for Women and Children (Women and Children’s Hospital of Chongqing Medical University), Chongqing, China
| | - Yili Li
- Department of Breast and Thyroid Surgery, Chongqing Health Center for Women and Children (Women and Children’s Hospital of Chongqing Medical University), Chongqing, China
| | - Lili Jiang
- Department of Breast and Thyroid Surgery, Chongqing Health Center for Women and Children (Women and Children’s Hospital of Chongqing Medical University), Chongqing, China
| | - Han Gao
- Department of Breast and Thyroid Surgery, Chongqing Health Center for Women and Children (Women and Children’s Hospital of Chongqing Medical University), Chongqing, China
- * E-mail:
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Dariushnia SR, Mitchell JW, Chaudry G, Hogan MJ. Society of Interventional Radiology Quality Improvement Standards for Image-Guided Percutaneous Drainage and Aspiration of Abscesses and Fluid Collections. J Vasc Interv Radiol 2020; 31:662-666.e4. [PMID: 32061521 DOI: 10.1016/j.jvir.2019.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 12/26/2022] Open
Affiliation(s)
- Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Georgia.
| | - Jason W Mitchell
- Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida
| | - Gulraiz Chaudry
- Division of Interventional Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Mark J Hogan
- Department of Radiology, Section of Vascular and Interventional Radiology, Nationwide Children's Hospital, Columbus, Ohio
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Ainge-Allen HW, Lilburn PA, Moses D, Chen C, Thomas PS. Antibiotic instillation for a chronic lung abscess. Respir Med Case Rep 2020; 29:100991. [PMID: 31908918 PMCID: PMC6940720 DOI: 10.1016/j.rmcr.2019.100991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/26/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Antibiotic treatment of lung abscesses fails in 10-20% of cases and require surgery, however, some are unsuitable for resection. Alternative options carry significant morbidity. Case report A 47 year old man with inoperable non-small cell lung cancer developed a lung abscess following definitive radiotherapy. Initial antibiotic therapy was successful, however four years later his symptoms recurred. Despite multiple courses his symptoms recurred despite long-term antibiotics. Immediately following a diagnostic aspiration, ceftriaxone and metronidazole were instilled into the abscess with subsequent clinical and radiological resolution. Discussion Lung abscesses are an uncommon complication of radiotherapy. Antibiotic therapy can fail for a number of reasons. Although instillation of antibiotics has not been described in the management of lung abscesses, the direct application of antifungals for aspergillomas is well documented and case series report success in other abscess sites. Conclusion Direct antibiotic instillation following lung abscess aspiration adds minimal risk and is potentially curative.
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Affiliation(s)
- Henry W. Ainge-Allen
- Department of Respiratory Medicine, Prince of Wales' Hospital, Australia
- Prince of Wales' Clinical School, University of New South Wales, NSW, Australia
- Corresponding author. Department of Respiratory Medicine, Prince of Wales, Randwick, NSW, 2031, Australia.
| | - Paul A. Lilburn
- Department of Respiratory Medicine, Prince of Wales' Hospital, Australia
| | - Daniel Moses
- Prince of Wales' Clinical School, University of New South Wales, NSW, Australia
- Department of Radiology, Prince of Wales' Hospital, Australia
| | - Colin Chen
- Prince of Wales' Clinical School, University of New South Wales, NSW, Australia
- Department of Radiation Oncology, Prince of Wales' Hospital, Australia
| | - Paul S. Thomas
- Department of Respiratory Medicine, Prince of Wales' Hospital, Australia
- Prince of Wales' Clinical School, University of New South Wales, NSW, Australia
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Zator Z, Klinge M, Schraut W, Tsung A, Khalid A. One step endoscopic ultrasound guided management of pelvic abscesses: a case series. Therap Adv Gastroenterol 2018; 11:1756284818785574. [PMID: 30034531 PMCID: PMC6048614 DOI: 10.1177/1756284818785574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 05/29/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Endoscopic management of pelvic abscesses not amenable to percutaneous drainage has been described. The technique employs endoscopic ultrasound (EUS)-guided placement of stents or drains, which may require multiple procedures, is cumbersome and uncomfortable for the patient. We describe the successful management of these abscesses in a single step involving EUS-guided lavage and instillation of antibiotics. METHODS Six consecutive patients with seven symptomatic pelvic abscesses not amenable to percutaneous drainage were referred for EUS-guided drainage. The abscesses were aspirated with a 19-gauge needle under EUS guidance and serially lavaged with an equal aspirate to instillation volume of sterile saline until cleared of pus. The residual cavity was then instilled with gentamicin 40 mg/ml. Patients were followed clinically and radiographically with repeat computed tomography or magnetic resonance imaging. RESULTS All patients had rapid resolution of symptoms. The abscesses disappeared completely in four patients. One patient with recurrent diverticulitis and abscess had marked decrease in abscess size and inflammation to permit planned sigmoid resection. One patient with Crohn's disease had clinical improvement and marked decrease in abscess size, permitting outpatient management of Crohn's disease. CONCLUSIONS EUS-guided lavage and instillation of antibiotics is a simple, one-step approach in the management of pelvic abscesses and may obviate the need for prolonged drain management and repeat procedures in select cases.
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Affiliation(s)
- Zachary Zator
- Department of Medicine, The University of
Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Matthew Klinge
- Department of Medicine, The University of
Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Wolfgang Schraut
- Department of Surgery, VA Pittsburgh HealthCare
System, Pittsburgh, PA, USA
| | - Allan Tsung
- Department of Surgery, The University of
Pittsburgh Medical Center, Pittsburgh, PA, USA
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David M, Handa P, Castaldi M. Predictors of outcomes in managing breast abscesses-A large retrospective single-center analysis. Breast J 2018; 24:755-763. [PMID: 29781232 DOI: 10.1111/tbj.13053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 10/31/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022]
Abstract
We have retrospectively examined a wide range of clinical characteristics, sonographic features, microbiology, and antibiotic regimens in patients with breast abscesses to seek predictive features related to outcome. Because consensus for optimal treatment of breast abscesses has moved toward minimally invasive management using single or repeated needle aspiration (ASP) coupled with adjuvant antibiotics, we assessed whether any factors correlate with the need for repeat procedures by analyzing the number of ASPs and/or surgical incision and drainage (I&D) per abscess. We examined 127 abscesses in 114 patients from a single urban public hospital, and among clinical characteristics, we found that only smoking history (P = .021) and the presence of nipple rings (P = .005) were associated with greater likelihood of necessitating repeat for abscess resolution procedures. Neither diabetes, lactational status, and HIV nor ultrasound features imaging of an abscess including size >3 cm, multiloculation, rind thickness, or central vs peripheral location were correlated with the need for a repeat procedure. Likewise, no specific micro-organisms predicted a greater likelihood of requiring repeat procedures, and no specific initial antibiotic regimen (gram-positive and/or gram-negative or multiresistance coverage) impacted clinical outcomes. Our data indicate that no specific imaging abscess characteristics, type of micro-organism, or initial choice of antibiotics affect outcomes, and therefore, these features should not preclude attempts at conventional therapy by repeated aspiration and antibiotic treatment. While a smoking history and presence of a nipple ring may increase the risk of a prolonged course, the decision to change antibiotics or repeat aspiration should rely instead on clinical evaluation and judgment by experienced physicians.
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Affiliation(s)
- Miriam David
- Department of Radiology, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Priyanka Handa
- Department of Radiology, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maria Castaldi
- Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Tchaou M, Darre T, Amavi AK, Kanassoua KK, N'Timon B, Sonhaye L, Agoda-Koussema LK, Adjenou K. Breast Abscessed Cancer in Nonlactating Women in Tropical Environment: Radiological, Bacteriological, and Anatomopathological Features about 3 Cases. Case Rep Radiol 2017; 2017:1639847. [PMID: 28932615 PMCID: PMC5591997 DOI: 10.1155/2017/1639847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 07/25/2017] [Indexed: 11/21/2022] Open
Abstract
The association of breast cancer and abscess is rare in daily practice. The authors report a short series of 3 cases of cancer of the breast in nonlactating women presented as breast abscess, reviewing aspects in radiology (ultrasound and mammography), correlating them with the histopathology findings and the bacteriological profile of the isolated germs.
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Affiliation(s)
- Mazamaesso Tchaou
- University Teaching Hospital of Lomé, Department of Radiology, Lomé, Togo
| | - Tchin Darre
- University Teaching Hospital of Lomé, Department of Pathology, Lomé, Togo
| | - Ayi Kossi Amavi
- University Teaching Hospital of Lomé, Department of General Surgery, Lomé, Togo
| | | | - Bidamin N'Timon
- University Teaching Hospital of Lomé, Department of Radiology, Lomé, Togo
| | - Lantam Sonhaye
- University Teaching Hospital of Lomé, Department of Radiology, Lomé, Togo
| | | | - Komlavi Adjenou
- University Teaching Hospital of Lomé, Department of Radiology, Lomé, Togo
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Lipatov KV, Komarova EA, Nasibov BS. [Peculiarities of the course, diagnosis and surgical treatment of non-lactating mastitis]. Khirurgiia (Mosk) 2017:25-30. [PMID: 28091453 DOI: 10.17116/hirurgia20161225-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To improve treatment of patients with non-lactating mastitis through the study of the course, diagnosis and surgical treatment. MATERIAL AND METHODS The study included 336 women aged 18-72 years with non-lactating mastitis who were hospitalized into the clinic for the period 1999-2016. RESULTS Main clinical variants of the disease, spectrum of pathogens and its relationship with clinical forms of mastitis were determined. Also early and long-term outcomes were evaluated followed by formulation of therapeutic and diagnostic concept of surgical care for non-lactating mastitis. Thus, good results were obtained in most cases (95.8% in early period and 92.6% in long-term period). CONCLUSION Only differentiated approach to diagnostic and curative tactics will allow to achieve good cosmetic and functional results in these patients.
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Affiliation(s)
- K V Lipatov
- Department of General Surgery, Medical Faculty of Sechenov First Moscow State Medical University
| | - E A Komarova
- Department of General Surgery, Medical Faculty of Sechenov First Moscow State Medical University
| | - B Sh Nasibov
- Department of General Surgery, Medical Faculty of Sechenov First Moscow State Medical University
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8
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Theoretical approach to local infusion of antibiotics for infected pancreatic necrosis. Pancreatology 2016; 16:719-25. [PMID: 27267056 DOI: 10.1016/j.pan.2016.05.396] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/03/2016] [Accepted: 05/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Infected pancreatic necrosis is a major complications of acute pancreatitis. If drainage is required, local administration of antibiotics through transmural nasocystic or percutaneous catheter may allow increasing local antibiotic concentrations. Drug diffusion becomes the main factor influencing local drug tissue penetration. The present study aims at providing the rationale for the design of new research protocols evaluating the efficacy of local antibiotics for infected pancreatic necrosis. METHODS A review of microbiological data was performed for the most common organisms causing the infection, antibiotics spectrum and minimum inhibitory concentrations (MIC). A search of the physico-chemical properties of antibiotics was performed to calculate the diffusion coefficients. An estimation of the antibiotic concentrations in pancreatic tissue was obtained using a mathematical model. Efficacy factors (EF) were calculated and the stability of the antibiotic solutions were evaluated to optimize the dosing regimen. RESULTS Piperacillin, vancomycin and metronidazole achieve high concentrations in the surrounding tissue very fast. Imipenem, ceftriaxone, ciprofloxacin, gentamicin, linezolid and cloxacillin achieve intermediate concentration values. Tigecycline, showed the lowest concentration values (<2 mg/L). Calculated EF is highest for piperacillin and imipenem short after administration and near to surface diffusion area (0.5 cm), but EF of imipenem is higher at deeper areas and longer time after administration. CONCLUSIONS Considering obtained results, some solutions are proposed using saline as diluent and 25 °C of temperature during administration. Imipenem has the best theoretical results in empiric local treatment. Linezolid and tigecycline solutions are not recommended.
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Debord MP, Poirier E, Delgado H, Charlot M, Colin C, Raudrant D, Golfier F, Dupuis O. Abcès du sein lactant : et si on ne les opérait plus ? ACTA ACUST UNITED AC 2016; 45:307-14. [DOI: 10.1016/j.jgyn.2015.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 03/12/2015] [Accepted: 04/01/2015] [Indexed: 11/27/2022]
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Shah A, Ahmed I, Hassan S, Samoon A, Ali B. Evaluation of ultrasonography as a diagnostic tool in the management of head and neck facial space infections: A clinical study. Natl J Maxillofac Surg 2015; 6:55-61. [PMID: 26668454 PMCID: PMC4668734 DOI: 10.4103/0975-5950.168213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction: Superficial facial space infections represent a significant amount of the dental problems that present to hospital. Determining whether an odontogenic swelling is a cellulitis or abscess is difficult, but important as both may require different treatments. The use of an ultrasound may aid in differentiating cellulitis and abscess. This study was done to compare the accuracy of clinical examination alone versus ultrasonography (USG) in the diagnosis of cellulitis and abscess in symptomatic patients with a diagnosis of superficial facial space infection. Materials and Methods: Twenty patients (1870 years) diagnosed as superficial facial space infections by clinical and radiographic examinations were included in the study and patients with significant medical conditions were excluded. The provisional clinical diagnosis was made after a thorough history was taken and clinical examination was performed to determine if the swelling was a cellulitis or abscess. Swelling was then evaluated using the ultrasonic transducer which was placed over the swelling to aid the diagnosis which was again recorded. An incision and drainage procedure was performed after the administration of local anesthesia. The success of the ultrasound intervention versus clinical examination was based on whether frank exudation was detected during incision and drainage of such swellings. Results: The statistical analysis found that USG is a valuable diagnostic aid for detection of abscess or cellulitis in head and neck facial space infections. Interpretation and Conclusion: The findings of this prospective analysis indicate that there was statistical difference between clinical examination alone and USG in making the correct diagnosis. The sensitivity, specificity, positive predictive, negative predictive, and accuracy were not similar for all methods tested. From the results of this study, ultrasound is recommended as an adjunct to clinical examination in differentiating between cellulitis and abscess.
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Affiliation(s)
- Ajaz Shah
- Department of Oral and Maxillofacial Surgery, Government Dental College, Srinagar, Jammu and Kashmir, India
| | - Irshad Ahmed
- Department of Oral and Maxillofacial Surgery, Government Dental College, Srinagar, Jammu and Kashmir, India
| | - Shahid Hassan
- Department of Oral and Maxillofacial Surgery, Government Dental College, Srinagar, Jammu and Kashmir, India
| | - Amina Samoon
- Department of Oral and Maxillofacial Surgery, Government Dental College, Srinagar, Jammu and Kashmir, India
| | - Babar Ali
- Department of Oral and Maxillofacial Surgery, Government Dental College, Srinagar, Jammu and Kashmir, India
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Laas E, Touboul C, Kerdraon O, Catteau-Jonard S. Mastites inflammatoires et infectieuses du sein en dehors de la grossesse et de la période d’allaitement : recommandations. ACTA ACUST UNITED AC 2015; 44:996-1016. [DOI: 10.1016/j.jgyn.2015.09.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022]
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Giess CS, Golshan M, Flaherty K, Birdwell RL. Clinical experience with aspiration of breast abscesses based on size and etiology at an academic medical center. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:513-521. [PMID: 24975466 DOI: 10.1002/jcu.22191] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/26/2014] [Accepted: 06/03/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE Our purpose was to review needle aspiration of breast abscesses and identify factors associated with treatment by aspiration alone versus aspiration with surgical incision and drainage (I/D). METHODS This Institutional Review Board-approved, retrospective review of the breast ultrasound database from 2008 to 2010 identified 40 patients (41 abscesses) who underwent aspiration, with or without I/D. Demographics, imaging, number of aspirations, and microbiology were reviewed. RESULTS Twenty-two abscesses underwent aspiration only, 16 > 3 cm, 6 ≤ 3 cm (mean 4.3 cm, range 0.9-10 cm). Known risk factors included lactational (11), 3 weeks post partum (1), pregnancy (1), recent biopsy/lumpectomy (5). Nineteen abscesses underwent aspiration and I/D, 15 > 3 cm, 4 ≤ 3 cm (mean 4.1 cm, range 2.2-7.5 cm). Known risk factors included lactational (4), recurrent subareolar abscess (4), diabetes (3), hydradenitis suppuritiva (1), nipple piercing (2), smoking (1), pregnancy (1), HIV (1), and lumpectomy (1). Identified reasons for I/D included lack of improvement/recurrence (12), fistula (3), and one electively after clinical improvement of a recurrent subareolar abscess. CONCLUSIONS Abscesses associated with pregnancy and lactation or breast biopsy are effectively managed with aspiration, even when large. Recurrence, chronicity, or fistula may require surgical intervention.
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Affiliation(s)
- Catherine S Giess
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115
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13
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Lam E, Chan T, Wiseman SM. Breast abscess: evidence based management recommendations. Expert Rev Anti Infect Ther 2014; 12:753-62. [PMID: 24791941 DOI: 10.1586/14787210.2014.913982] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Literature review was carried out and studies reporting on treatment of breast abscesses were critically appraised for quality and their level of evidence using the Strength of Recommendation Taxonomy guidelines, and key recommendations were summarized. Needle aspiration either with or without ultrasound guidance should be employed as first line treatment of breast abscesses. This approach has the potential benefits of: superior cosmesis, shorter healing time, and avoidance of general anaesthesia. Multiple aspiration sessions may be required for cure. Ultrasound-guided percutaneous catheter placement may be considered as an alternative approach for treatment of larger abscesses (>3 cm). Surgical incision and drainage should be considered for first line therapy in large (>5 cm), multiloculated, or long standing abscesses, or if percutaneous drainage is unsuccessful. All patients should be treated concurrently with antibiotics. Patients with recurrent subareolar abscesses and fistulas should be referred for consideration of surgical treatment.
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Affiliation(s)
- Elaine Lam
- Department of Surgery, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
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Poweski L, Drum M, Reader A, Nusstein J, Beck M, Chaudhry J. Role of ultrasonography in differentiating facial swellings of odontogenic origin. J Endod 2014; 40:495-8. [PMID: 24666898 DOI: 10.1016/j.joen.2014.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/14/2013] [Accepted: 01/03/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Differentiating an acute, odontogenic facial swelling clinically as cellulitis or an abscess has not been thoroughly investigated in endodontics. It has been suggested in the medical and dental literature that the use of ultrasound may aid in differentiating cellulitis from an abscess. Therefore, if ultrasound were more accurate than a blind incision for drainage procedure in locating purulence, perhaps the outcome of the incision for drainage procedure would be beneficial in the resolution of odontogenic infections. The purpose of this prospective study was to compare clinical examination plus ultrasonography versus clinical examination alone in differentiating cellulitis from abscesses in patients with facial swelling of odontogenic origin. METHODS Eighty-two emergency patients participated in this study. Each patient was examined and diagnosed by clinical examination and clinical examination plus ultrasonography. An incision for drainage procedure was performed, and a definitive diagnosis was recorded as cellulitis (no purulence) or an abscess (presence of purulence). RESULTS With the incision for drainage procedure, cellulitis occurred 37% of the time and abscesses 63%. With clinical examination alone, a correct diagnosis was made 68% of the time. With clinical examination plus ultrasonography, a correct diagnosis was made 70% of the time. There was no statistically significant difference between the 2 examination methods. CONCLUSIONS The addition of ultrasonography to a clinical examination did not significantly increase the number of correct diagnoses.
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Affiliation(s)
| | - Melissa Drum
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Al Reader
- Division of Endodontics, The Ohio State University, Columbus, Ohio.
| | - John Nusstein
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Mike Beck
- Division of Oral Biology, The Ohio State University, Columbus, Ohio
| | - Jahanzeb Chaudhry
- Division of Oral and Maxillofacial Pathology, The Ohio State University, Columbus, Ohio
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Branch-Elliman W, Lee GM, Golen TH, Gold HS, Baldini LM, Wright SB. Health and economic burden of post-partum Staphylococcus aureus breast abscess. PLoS One 2013; 8:e73155. [PMID: 24039877 PMCID: PMC3764182 DOI: 10.1371/journal.pone.0073155] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 07/17/2013] [Indexed: 12/05/2022] Open
Abstract
Objectives To determine the health and economic burdens of post-partum Staphylococcus aureus breast abscess. Study design We conducted a matched cohort study (N = 216) in a population of pregnant women (N = 32,770) who delivered at our center during the study period from 10/1/03–9/30/10. Data were extracted from hospital databases, or via chart review if unavailable electronically. We compared cases of S. aureus breast abscess to controls matched by delivery date to compare health services utilization and mean attributable medical costs in 2012 United States dollars using Medicare and hospital-based estimates. We also evaluated whether resource utilization and health care costs differed between cases with methicillin-resistant and -susceptible S. aureus isolates. Results Fifty-four cases of culture-confirmed post-partum S. aureus breast abscess were identified. Breastfeeding cessation (41%), milk fistula (11.1%) and hospital readmission (50%) occurred frequently among case patients. Breast abscess case patients had high rates of health services utilization compared to controls, including high rates of imaging and drainage procedures. The mean attributable cost of post-partum S. aureus breast abscess ranged from $2,340–$4,012, depending on the methods and data sources used. Mean attributable costs were not significantly higher among methicillin-resistant vs. –susceptible S. aureus cases. Conclusions Post-partum S. aureus breast abscess is associated with worse health and economic outcomes for women and their infants, including high rates of breastfeeding cessation. Future study is needed to determine the optimal treatment and prevention of these infections.
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Affiliation(s)
- Westyn Branch-Elliman
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Division of Infection Control/Hospital Epidemiology. Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
| | - Grace M. Lee
- Department of Population Medicine, Center for Child Health Care Studies, Harvard Pilgrim Institute and Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Pediatric Infectious Disease and Department of Laboratory Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Toni H. Golen
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Howard S. Gold
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Division of Infection Control/Hospital Epidemiology. Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Linda M. Baldini
- Division of Infection Control/Hospital Epidemiology. Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Sharon B. Wright
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Division of Infection Control/Hospital Epidemiology. Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
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16
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Naeem M, Rahimnajjad MK, Rahimnajjad NA, Ahmed QJ, Fazel PA, Owais M. Comparison of Incision and Drainage against Needle Aspiration for the Treatment of Breast Abscess. Am Surg 2012. [DOI: 10.1177/000313481207801129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We aim to compare the incision and drainage against ultrasound-guided aspiration for the treatment of breast abscesses. Sixty-four patients were randomly allocated to Group A (incision and drainage) and Group B (needle aspiration). Incision and drainage was done under general, whereas aspiration was done under local anesthesia with antibiotic coverage after the pus sample was taken for cultures. Time taken to resolve symptoms including point tenderness, erythema and hyperthermia, recurrence of breast abscess, and healing time was recorded. Patients were followed until 8 weeks. Culture and sensitivity of the pus were done. Data were analyzed in SPSS 16.0. The mean difference of healing time was significant ( P = 0.001). A total of 93.3 per cent were healed in Group B and 76.6 per cent in Group A ( P = 0.033). Twenty-two samples (34.37%) had no bacterial yield and the remaining 42 samples (65.6%) yielded 11 anaerobic cultures (17.18%) and 31 aerobic cultures (48.4%). Ultrasound-guided aspiration of breast abscesses with the judicious use of antibiotics is a better treatment modality than incision and drainage.
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Affiliation(s)
- Muhammad Naeem
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | | | - Pyar Ali Fazel
- Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Owais
- Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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17
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Chick JFB, Chauhan NR, Polen LA. Emergency management of puerperal breast abscess. Intern Emerg Med 2012; 7 Suppl 2:S167-8. [PMID: 22773189 DOI: 10.1007/s11739-012-0813-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Jeffrey Forris Beecham Chick
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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18
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Trop I, Dugas A, David J, El Khoury M, Boileau JF, Larouche N, Lalonde L. Breast Abscesses: Evidence-based Algorithms for Diagnosis, Management, and Follow-up. Radiographics 2011; 31:1683-99. [DOI: 10.1148/rg.316115521] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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19
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Al Benwan K, Al Mulla A, Rotimi VO. A study of the microbiology of breast abscess in a teaching hospital in Kuwait. Med Princ Pract 2011; 20:422-6. [PMID: 21757930 DOI: 10.1159/000327659] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 02/14/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To determine the microbiological profile of breast abscess and assess the antibiotic susceptibility of the causative agents. MATERIALS AND METHODS Data obtained from cases of breast abscess over a period of 3.5 years, June 2006 to December 2009, were retrospectively analyzed. Specimens were cultured using optimal aerobic and anaerobic microbiological techniques. The antibiotic susceptibility test was carried out using the methods recommended by the Clinical and Laboratory Standards Institute. One specimen per patient was analyzed. RESULTS Of the 114 patients, 107 (93.8%) non-lactating and 7 (6.1%) lactating women were diagnosed with breast abscess during this period. Of the 114 specimens, 83 (73%) yielded bacterial growth. Of these, 115 pathogens were isolated with an average of 1.4 pathogens per abscess. Eighteen (22%) of the 83 specimens yielded mixed bacterial growth. There were more Gram-positive pathogens (60, 52%) than anaerobes (32, 28%) and Gram-negative pathogens (22, 19%). The predominant organisms were methicillin-susceptible Staphylococcus aureus (37, 32%), methicillin-resistant S. aureus (MRSA; 11, 10%), Bacteroides spp. (16, 14%), anaerobic streptococci (14, 12%) and Pseudomonas aeruginosa (9, 8%). Of the 48 S. aureus, MRSA accounted for 11 (23%). All MRSA isolates were susceptible to trimethoprim-sulfamethoxazole and vancomycin. CONCLUSION S. aureus was the most common pathogenic organism isolated in breast abscesses at Al-Amiri Hospital, Kuwait, of which 23% were MRSA. Nearly a third of the cases were caused by anaerobes, particularly B. fragilis. The data present a basis for the formation of empirical antimicrobial therapeutic policy in the management of breast abscess.
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20
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Quality Improvement Guidelines for Percutaneous Drainage/Aspiration of Abscess and Fluid Collections. J Vasc Interv Radiol 2010; 21:431-5. [DOI: 10.1016/j.jvir.2009.12.398] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 11/11/2009] [Accepted: 12/09/2009] [Indexed: 01/31/2023] Open
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21
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Kamal RM, Hamed ST, Salem DS. Classification of Inflammatory Breast Disorders and Step by Step Diagnosis. Breast J 2009; 15:367-80. [DOI: 10.1111/j.1524-4741.2009.00740.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Ozseker B, Ozcan UA, Rasa K, Cizmeli OM. Treatment of breast abscesses with ultrasound-guided aspiration and irrigation in the emergency setting. Emerg Radiol 2008; 15:105-8. [PMID: 18193464 DOI: 10.1007/s10140-007-0683-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Accepted: 10/23/2007] [Indexed: 11/25/2022]
Abstract
The purpose of our study was to describe the efficacy of ultrasound (US)-guided aspiration and intracavitary irrigation of breast abscesses in the emergency setting. Ten cases of mastitis clinically suspected of having a breast abscess were referred from the emergency department for breast ultrasound. Eleven abscesses depicted at US were treated with US-guided aspiration and intracavitary irrigation. All patients were given antibiotics, and the success of US-guided treatment was determined. Three abscesses that were smaller than 3 cm were treated with single aspiration and irrigation. Ninety-one percent of patients were cured with US-guided aspiration and irrigation requiring no further surgical intervention. One case of chronic mastitis fistulized to the skin and was drained surgically. No recurrences were observed in the follow-up period. US-guided percutaneous aspiration and irrigation is a successful method for treatment of breast abscesses in the emergency setting. This method is more successful in abscesses with a maximum dimension smaller than 3 cm and should be preferred to the surgical drainage.
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Affiliation(s)
- Bulent Ozseker
- Department of Radiology, Acibadem Hospital, Inonu cd. Okur sk., Kozyatagi, 34742, Istanbul, Turkey
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23
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Agrawal A, Kissin M. Breast abscess. Br J Hosp Med (Lond) 2007; 68:M198-9. [PMID: 18087852 DOI: 10.12968/hmed.2007.68.sup11.27698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Avi Agrawal
- Breast Unit, Portsmouth NHS Hospitals, Portsmouth
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24
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Beyrouti MI, Boujelben S, Beyrouti R, Ben Amar M, Abid M, Louati D, Zidi Z, Ben Salah K, Abid O, Ghorbel A. [Pyogenic abscess of the breast: clinical and therapeutic aspects]. ACTA ACUST UNITED AC 2007; 35:645-50. [PMID: 17590375 DOI: 10.1016/j.gyobfe.2007.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Accepted: 05/11/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goal of this retrospective work was to study the clinical aspects and the principles of management of the abscess of the breast in order to determine a convenient and recent therapeutic attitude. PATIENTS AND METHODS Our retrospective survey concerns 114 cases of breast abscess collected in a surgery department over a period of 14 years, from 1990 to 2003. All patients have been operated and the diagnosis confirmed through the operation. The puerperal abscesses have been noted in 31 cases. RESULTS One hundred and four women and ten men were concerned, with a sex-ratio of 0.1. The medium age was 33 years old for the women and 42 years for the men. The diagnosis was based on the clinical criteria, confirmed by the ultrasonography in 11 cases out of 16 and by the mammary puncture in 15 cases out of 22. Two non-puerperal abscesses have revealed an infiltrating canal carcinoma. The Staphylococcus aureus was the germ the most frequently met, concerning 8 cases out of 16. The surgical biopsies carried out in 52 cases revealed a fibrocystic mastopathy in six cases, a canalar ectasia in two cases and an infiltrating canalar carcinoma in two cases. The surgical treatment, performed in any case, was associated to an anti-staphylococcus antibiotherapy. The recurrence of the abscess has been observed in four cases. DISCUSSION AND CONCLUSION The frequency of pyogenic abscess of the breast, particularly the puerperal abscesses, has considerably decreased. The non-puerperal abscesses often pose a differential diagnosis problem with the very aggressive inflammatory cancers. The percutaneous ultrasonography guided drainage must be proposed in first intention to treat the abscesses of the breast. However, surgical treatment is still valid with an abscess either relapsing or chronic, or else the failure of the non-operative processes.
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Affiliation(s)
- M I Beyrouti
- Service de chirurgie générale, EPS Habib-Bourguiba, 3029 Sfax, Tunisie.
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25
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Scott BG, Silberfein EJ, Pham HQ, Feanny MA, Lassinger BK, Welsh FJ, Carrick MM. Rate of malignancies in breast abscesses and argument for ultrasound drainage. Am J Surg 2006; 192:869-72. [DOI: 10.1016/j.amjsurg.2006.08.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Revised: 08/10/2006] [Accepted: 08/10/2006] [Indexed: 10/23/2022]
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26
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Shulman SG, March DE. Ultrasound-Guided Breast Interventions: Accuracy of Biopsy Techniques and Applications in Patient Management. Semin Ultrasound CT MR 2006; 27:298-307. [PMID: 16915998 DOI: 10.1053/j.sult.2006.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ultrasound (US) provides a versatile approach for guiding biopsies and other breast interventions. The wide availability, real-time capability, technical improvements, and increasing user experience have greatly expanded the role of US-guided interventions in the diagnosis and management of breast disease. This article reviews the accuracy of US-guided fine-needle aspiration biopsy, automated core biopsy, and vacuum-assisted biopsy. Some of the more specialized procedures that reflect the growing role of US-guided interventions in patient management will also be discussed.
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Affiliation(s)
- Suzanne G Shulman
- Department of Radiology, Baystate Medical Center, Springfield, Massachusetts 01199, USA
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Kim HS, Cha ES, Kim HH, Yoo JY. Spectrum of sonographic findings in superficial breast masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:663-680. [PMID: 15840798 DOI: 10.7863/jum.2005.24.5.663] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The purpose of this presentation is to show the sonographic findings of breast masses, which can occur in subcutaneous fat or in the cutaneous layer of the breast. METHODS We reviewed the sonographic findings of superficial breast masses, including the epidermal inclusion cyst, steatocystoma multiplex, fat necrosis, accessory breast, Mondor disease, sparganosis, neurofibroma, tuberculosis, mastitis, and breast malignancy. RESULTS Specific sonographic features of superficial breast masses have been illustrated. CONCLUSIONS Radiologists must be familiar with the sonographic findings of various diseases involving the superficial layer of the breast to avoid further patient workup.
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Affiliation(s)
- Hyeon Sook Kim
- Department of Radiology, St Paul's Hospital, Medical College, Suwon, Korea
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