Mastitis differential diagnosis: Difference between revisions
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A milk retention cyst may cause a tender palpable breast lump, but there are usually no sharp shooting pains and no signs of breast inflammation or systemic illness. A galactocele appears on ultrasound as a well-defined lesion with a thin echogenic wall, which may contain coarse calcification. A breast abscess may also be well circumscribed, macrolobulated, irregular, or ill defined with possible septae. <ref name="pmid26341843">{{cite journal| author=Langer A, Mohallem M, Berment H, Ferreira F, Gog A, Khalifa D et al.| title=Breast lumps in pregnant women. | journal=Diagn Interv Imaging | year= 2015 | volume= 96 | issue= 10 | pages= 1077-87 | pmid=26341843 | doi=10.1016/j.diii.2015.07.005 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26341843 }} </ref> <ref name="pmid26530177">{{cite journal| author=Canlorbe G, Bendifallah S| title=[Rare benign breast tumors including Abrikossoff tumor (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma: Guidelines for clinical practice]. | journal=J Gynecol Obstet Biol Reprod (Paris) | year= 2015 | volume= 44 | issue= 10 | pages= 1030-48 | pmid=26530177 | doi=10.1016/j.jgyn.2015.09.034 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26530177 }} </ref> | A milk retention cyst may cause a tender palpable breast lump, but there are usually no sharp shooting pains and no signs of breast inflammation or systemic illness. A galactocele appears on ultrasound as a well-defined lesion with a thin echogenic wall, which may contain coarse calcification. A breast abscess may also be well circumscribed, macrolobulated, irregular, or ill defined with possible septae. <ref name="pmid26341843">{{cite journal| author=Langer A, Mohallem M, Berment H, Ferreira F, Gog A, Khalifa D et al.| title=Breast lumps in pregnant women. | journal=Diagn Interv Imaging | year= 2015 | volume= 96 | issue= 10 | pages= 1077-87 | pmid=26341843 | doi=10.1016/j.diii.2015.07.005 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26341843 }} </ref> <ref name="pmid26530177">{{cite journal| author=Canlorbe G, Bendifallah S| title=[Rare benign breast tumors including Abrikossoff tumor (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma: Guidelines for clinical practice]. | journal=J Gynecol Obstet Biol Reprod (Paris) | year= 2015 | volume= 44 | issue= 10 | pages= 1030-48 | pmid=26530177 | doi=10.1016/j.jgyn.2015.09.034 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26530177 }} </ref> | ||
Galactocele aspiration yields nonpurulent milk. | Galactocele aspiration yields nonpurulent milk. | ||
===Breast engorgement=== | ===Breast engorgement=== | ||
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===Mastodynia=== | ===Mastodynia=== | ||
Mastalgia may be cyclic or noncyclic with menstruation. | Mastalgia may be cyclic or noncyclic with menstruation. | ||
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===Fibrocystic breasts=== | ===Fibrocystic breasts=== | ||
Painful breast tissue before menses improves during menstruation. | Painful breast tissue before menses improves during menstruation. | ||
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Mammography is only indicated to help with diagnosis of fibrocystic disease in older women, not adolescents, because the density of breast tissue in adolescents makes interpretation difficult. | Mammography is only indicated to help with diagnosis of fibrocystic disease in older women, not adolescents, because the density of breast tissue in adolescents makes interpretation difficult. | ||
===Primary invasive breast cancer=== | ===Primary invasive breast cancer=== | ||
The signs and symptoms of breast cancer may be similar to those of breast infection. | The signs and symptoms of breast cancer may be similar to those of breast infection. | ||
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A skin-punch biopsy for inflammatory breast carcinoma will show tumor infiltration of dermal lymphatics. | A skin-punch biopsy for inflammatory breast carcinoma will show tumor infiltration of dermal lymphatics. | ||
===Fibroadenoma=== | ===Fibroadenoma=== | ||
Presents typically as a nontender, rubbery, well-circumscribed, and mobile mass. | Presents typically as a nontender, rubbery, well-circumscribed, and mobile mass. | ||
Imaging studies, such as breast ultrasound and mammography, generally reveal a solid, homogeneous, well-circumscribed, avascular mass with occasional coarse calcification. | Imaging studies, such as breast ultrasound and mammography, generally reveal a solid, homogeneous, well-circumscribed, avascular mass with occasional coarse calcification. | ||
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===Breast trauma=== | ===Breast trauma=== | ||
Trauma may cause fat necrosis, which could manifest as a breast mass. | Trauma may cause fat necrosis, which could manifest as a breast mass. | ||
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Signs of inflammation are uncommon. | Signs of inflammation are uncommon. | ||
Imaging studies may mimic carcinoma (as also occurs on occasion with breast infection). | Imaging studies may mimic carcinoma (as also occurs on occasion with breast infection). | ||
A biopsy may be indicated for a definitive diagnosis. | A biopsy may be indicated for a definitive diagnosis. | ||
===Fat necrosis=== | ===Fat necrosis=== | ||
Typically results in a tender, round, firm breast mass. | Typically results in a tender, round, firm breast mass. | ||
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Inflammation is usually not a common feature unless there is an associated infection. | Inflammation is usually not a common feature unless there is an associated infection. | ||
Breast imaging findings may not be specific. | Breast imaging findings may not be specific. | ||
A breast biopsy is the most accurate means of providing a definitive diagnosis. | A breast biopsy is the most accurate means of providing a definitive diagnosis. | ||
===Mondor disease=== | ===Mondor disease=== | ||
Thrombophlebitis of a superficial vein may cause breast pain and a cord-like mass with possible skin dimpling, usually in the lower quadrants. | Thrombophlebitis of a superficial vein may cause breast pain and a cord-like mass with possible skin dimpling, usually in the lower quadrants. | ||
The cord is accentuated by traction, elevation of the breast, or abduction of the ipsilateral arm. | The cord is accentuated by traction, elevation of the breast, or abduction of the ipsilateral arm. | ||
Mammography and a microbiology workup are usually negative. | Mammography and a microbiology workup are usually negative. | ||
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Patients may have other autoimmune diseases. | Patients may have other autoimmune diseases. | ||
Breast imaging studies may be nonspecific and can mimic cancer. | Breast imaging studies may be nonspecific and can mimic cancer. | ||
Biopsy shows sclerosing lobular lymphocytic mastitis. | Biopsy shows sclerosing lobular lymphocytic mastitis. | ||
===Necrotizing fasciitis=== | ===Necrotizing fasciitis=== | ||
Patients may have fever, chills, and extreme pain associated with rapidly advancing skin erythema, and possible cyanosis, vesicles, bullae, ulcers, crepitation, and a black necrotic eschar. | Patients may have fever, chills, and extreme pain associated with rapidly advancing skin erythema, and possible cyanosis, vesicles, bullae, ulcers, crepitation, and a black necrotic eschar. | ||
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A history of prior trauma, skin biopsy, or a surgical wound in the mammary region may be reported. | A history of prior trauma, skin biopsy, or a surgical wound in the mammary region may be reported. | ||
Laboratory tests may show leukocytosis, elevated BUN, and reduced serum sodium level. | Laboratory tests may show leukocytosis, elevated BUN, and reduced serum sodium level. | ||
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===Hidradenitis suppurativa=== | ===Hidradenitis suppurativa=== | ||
Presents mainly around hair follicles in the axilla and intertriginous regions under the breasts. | Presents mainly around hair follicles in the axilla and intertriginous regions under the breasts. | ||
Lesions range from comedones to painful lumps, abscesses, and skin scarring, and these may be associated with a purulent discharge. | Lesions range from comedones to painful lumps, abscesses, and skin scarring, and these may be associated with a purulent discharge. | ||
A biopsy will show acute and chronic folliculitis with a possible foreign body giant cell inflammation. | A biopsy will show acute and chronic folliculitis with a possible foreign body giant cell inflammation. | ||
===Costochondritis=== | ===Costochondritis=== | ||
There is localized sternal pain, often exacerbated with respiration or activity. | There is localized sternal pain, often exacerbated with respiration or activity. | ||
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A breast examination is usually unremarkable. | A breast examination is usually unremarkable. | ||
Tests are not necessary. | Tests are not necessary. | ||
===Neonatal breast hypertrophy=== | ===Neonatal breast hypertrophy=== | ||
Benign breast enlargement may be transient. | Benign breast enlargement may be transient. | ||
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If present, a nipple discharge is milky and not purulent. | If present, a nipple discharge is milky and not purulent. | ||
Tests are not necessary | |||
Tests are not | |||
===Gigantomastia=== | ===Gigantomastia=== | ||
Massive hypertrophy of the breasts may occur early in pregnancy. | Massive hypertrophy of the breasts may occur early in pregnancy. | ||
There may be associated skin necrosis. | There may be associated skin necrosis. | ||
Microbiology studies may be required to exclude underlying infection. | Microbiology studies may be required to exclude underlying infection. | ||
===Impetigo=== | ===Impetigo=== | ||
Features of impetigo including vesicles/bullae and crusting. | Features of impetigo including vesicles/bullae and crusting. | ||
Usually clinical diagnosis. | Usually clinical diagnosis. | ||
===Furuncle=== | ===Furuncle=== | ||
Painful, tender, red swollen area that becomes cystic; may be accompanied by malaise or fever. | Painful, tender, red swollen area that becomes cystic; may be accompanied by malaise or fever. | ||
Usually clinical diagnosis | Usually clinical diagnosis | ||
Revision as of 15:06, 9 August 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]
Overview
Mastitis must be differentiated from other diseases that cause breast pain and/or swelling.
Differentiating Mastitis from other diseases
Mastitis must be differentiated from other diseases that cause breast pain and swelling as shown below:
Galactocele
A milk retention cyst may cause a tender palpable breast lump, but there are usually no sharp shooting pains and no signs of breast inflammation or systemic illness. A galactocele appears on ultrasound as a well-defined lesion with a thin echogenic wall, which may contain coarse calcification. A breast abscess may also be well circumscribed, macrolobulated, irregular, or ill defined with possible septae. [1] [2] Galactocele aspiration yields nonpurulent milk.
Breast engorgement
Engorgement usually occurs on the third to fifth postpartum day. There may be bilateral generalized breast pain, firmness, erythema, warmth, and a mild fever (milk fever), but there is usually no edema. Relieved by frequent emptying of the breasts (e.g., breastfeeding).[3] [4] [5]
Nipple sensitivity
There is usually no evidence of nipple trauma, features of breast inflammation, or fever.
Nipple vasospasm (Raynaud phenomenon) may manifest with nipple pain.
Nipple sensitivity with breastfeeding usually subsides once suckling begins, whereas pain from trauma or infection persists or increases. Usually becomes clinically apparent as breastfeeding continues.
Mastodynia
Mastalgia may be cyclic or noncyclic with menstruation.
There should be no symptoms or signs of breast inflammation.
Specific tests are not indicated.
Diagnosis is based on history and examination. [6] [7] [8]
Fibrocystic breasts
Painful breast tissue before menses improves during menstruation.
Lumps are palpated mainly in the upper outer quadrant.
A nonbloody nipple discharge may be reported.
Ultrasound may help diagnose benign cystic breast tissue.
Mammography is only indicated to help with diagnosis of fibrocystic disease in older women, not adolescents, because the density of breast tissue in adolescents makes interpretation difficult.
Primary invasive breast cancer
The signs and symptoms of breast cancer may be similar to those of breast infection.
It may present as a hard, irregular, painless mass that may or may not be fixed to the underlying tissue.
There may be a nipple discharge, nipple or skin retraction, skin edema (peau d'orange), and regional lymphadenopathy. Paget disease will involve the nipple.
Inflammatory breast cancer may resemble mastitis with breast enlargement, warmth, tenderness, edema, erythema, and possible skin discoloration.
Imaging studies, such as mammography, may reveal a mass, increased density, and microcalcification.
Percutaneous biopsy (recommended method), or surgical excision (excisional biopsy) if indicated, is necessary to establish the diagnosis.
A skin-punch biopsy for inflammatory breast carcinoma will show tumor infiltration of dermal lymphatics.
Fibroadenoma
Presents typically as a nontender, rubbery, well-circumscribed, and mobile mass. Imaging studies, such as breast ultrasound and mammography, generally reveal a solid, homogeneous, well-circumscribed, avascular mass with occasional coarse calcification. Pathologic examination will demonstrate a fibroepithelial lesion.
Breast trauma
Trauma may cause fat necrosis, which could manifest as a breast mass.
Signs of inflammation are uncommon.
Imaging studies may mimic carcinoma (as also occurs on occasion with breast infection).
A biopsy may be indicated for a definitive diagnosis.
Fat necrosis
Typically results in a tender, round, firm breast mass.
The skin may be dimpled over such a lump.
Inflammation is usually not a common feature unless there is an associated infection.
Breast imaging findings may not be specific.
A breast biopsy is the most accurate means of providing a definitive diagnosis.
Mondor disease
Thrombophlebitis of a superficial vein may cause breast pain and a cord-like mass with possible skin dimpling, usually in the lower quadrants.
The cord is accentuated by traction, elevation of the breast, or abduction of the ipsilateral arm. Mammography and a microbiology workup are usually negative.
Diabetes
May manifest with one or more hard, irregular, mobile, discrete, painless, palpable masses.
Complications arising from diabetes such as retinopathy, neuropathy, and nephropathy may be present.
Breast lesions tend to be recurrent and bilateral.
Patients may have other autoimmune diseases.
Breast imaging studies may be nonspecific and can mimic cancer.
Biopsy shows sclerosing lobular lymphocytic mastitis.
Necrotizing fasciitis
Patients may have fever, chills, and extreme pain associated with rapidly advancing skin erythema, and possible cyanosis, vesicles, bullae, ulcers, crepitation, and a black necrotic eschar.
Examination by an experienced surgeon is critical.
A history of prior trauma, skin biopsy, or a surgical wound in the mammary region may be reported.
Laboratory tests may show leukocytosis, elevated BUN, and reduced serum sodium level.
Infection can be diagnosed with rapid streptococcal diagnostic kits, if available.
Microbiology studies and excisional deep skin biopsy may be helpful in diagnosing and identifying the causative organisms and confirming the diagnosis.
Hidradenitis suppurativa
Presents mainly around hair follicles in the axilla and intertriginous regions under the breasts.
Lesions range from comedones to painful lumps, abscesses, and skin scarring, and these may be associated with a purulent discharge.
A biopsy will show acute and chronic folliculitis with a possible foreign body giant cell inflammation.
Costochondritis
There is localized sternal pain, often exacerbated with respiration or activity.
Pain may radiate.
A palpable swelling with redness is often located about 4 cm from the sternal edge.
A breast examination is usually unremarkable.
Tests are not necessary.
Neonatal breast hypertrophy
Benign breast enlargement may be transient.
The breast bud in such cases is not red or tender.
If present, a nipple discharge is milky and not purulent.
Tests are not necessary
Gigantomastia
Massive hypertrophy of the breasts may occur early in pregnancy.
There may be associated skin necrosis.
Microbiology studies may be required to exclude underlying infection.
Impetigo
Features of impetigo including vesicles/bullae and crusting.
Usually clinical diagnosis.
Furuncle
Painful, tender, red swollen area that becomes cystic; may be accompanied by malaise or fever. Usually clinical diagnosis
References
- ↑ Langer A, Mohallem M, Berment H, Ferreira F, Gog A, Khalifa D; et al. (2015). "Breast lumps in pregnant women". Diagn Interv Imaging. 96 (10): 1077–87. doi:10.1016/j.diii.2015.07.005. PMID 26341843.
- ↑ Canlorbe G, Bendifallah S (2015). "[Rare benign breast tumors including Abrikossoff tumor (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma: Guidelines for clinical practice]". J Gynecol Obstet Biol Reprod (Paris). 44 (10): 1030–48. doi:10.1016/j.jgyn.2015.09.034. PMID 26530177.
- ↑ Pustotina O (2016). "Management of mastitis and breast engorgement in breastfeeding women". J Matern Fetal Neonatal Med. 29 (19): 3121–5. doi:10.3109/14767058.2015.1114092. PMID 26513602.
- ↑ Leung SS (2016). "Breast pain in lactating mothers". Hong Kong Med J. doi:10.12809/hkmj154762. PMID 27313273.
- ↑ Anderson L, Kynoch K (2016). "Implementation of an education package on breast engorgement aimed at lactation consultants and midwives to prevent conflicting information for postnatal mothers". Int J Evid Based Healthc. doi:10.1097/XEB.0000000000000090. PMID 27465926.
- ↑ van Bogaert LJ (1986). "[Mastodynia and fibrocystic disease of the breast. Perspectives and methods of medical treatment]". J Gynecol Obstet Biol Reprod (Paris). 15 (6): 805–11. PMID 3794218.
- ↑ Songtish D, Akranurakkul P (2015). "Mastalgia: Characteristics and Associated Factors in Thai Women". J Med Assoc Thai. 98 Suppl 9: S9–15. PMID 26817204.
- ↑ Sen M, Kilic MO, Cemeroglu O, Icen D (2015). "Can mastalgia be another somatic symptom in fibromyalgia syndrome?". Clinics (Sao Paulo). 70 (11): 733–7. doi:10.6061/clinics/2015(11)03. PMC 4642489. PMID 26602519.