Mastitis differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
Mastitis must be differentiated from other diseases that cause breast pain and/or swelling | Mastitis must be differentiated from other diseases that cause breast pain and/or swelling, such as [[galactocele]]<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>, [[breast engorgement]]<ref name="pmid26513602">{{cite journal| author=Pustotina O| title=Management of mastitis and breast engorgement in breastfeeding women. | journal=J Matern Fetal Neonatal Med | year= 2016 | volume= 29 | issue= 19 | pages= 3121-5 | pmid=26513602 | doi=10.3109/14767058.2015.1114092 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26513602}}</ref><ref name="pmid27313273">{{cite journal| author=Leung SS| title=Breast pain in lactating mothers. | journal=Hong Kong Med J | year= 2016 | volume= | issue= | pages= | pmid=27313273 | doi=10.12809/hkmj154762 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27313273 }} </ref> <ref name="pmid27465926">{{cite journal| author=Anderson L, Kynoch K| title=Implementation of an education package on breast engorgement aimed at lactation consultants and midwives to prevent conflicting information for postnatal mothers. | journal=Int J Evid Based Healthc | year= 2016 | volume= | issue= | pages= | pmid=27465926 | doi=10.1097/XEB.0000000000000090 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27465926}}</ref>, [[mastodynia]]<ref name="pmid3794218">{{cite journal| author=van Bogaert LJ| title=[Mastodynia and fibrocystic disease of the breast. Perspectives and methods of medical treatment]. | journal=J Gynecol Obstet Biol Reprod (Paris) | year= 1986 | volume= 15 | issue= 6 | pages= 805-11 | pmid=3794218 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3794218}}</ref><ref name="pmid26817204">{{cite journal| author=Songtish D, Akranurakkul P| title=Mastalgia: Characteristics and Associated Factors in Thai Women. | journal=J Med Assoc Thai | year= 2015 | volume= 98 Suppl 9 | issue= | pages= S9-15 | pmid=26817204 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26817204}}</ref><ref name="pmid26602519">{{cite journal| author=Sen M, Kilic MO, Cemeroglu O, Icen D| title=Can mastalgia be another somatic symptom in fibromyalgia syndrome? | journal=Clinics (Sao Paulo) | year= 2015 | volume= 70 | issue= 11 | pages= 733-7 | pmid=26602519 | doi=10.6061/clinics/2015(11)03 | pmc=4642489 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26602519}}</ref>, [[fibrocystic breast disease]], [[breast cancer]], [[fibroadenoma]], [[mondor's disease]]<ref name="pmid9283940">{{cite journal| author=Cox EM, Siegel DM| title=Mondor disease: an unusual consideration in a young woman with a breast mass. | journal=J Adolesc Health | year= 1997 | volume= 21 | issue= 3 | pages= 183-5 | pmid=9283940 | doi=10.1016/S1054-139X(97)00044-X | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9283940}}</ref><ref name="pmid21855258">{{cite journal| author=Belleflamme M, Penaloza A, Thoma M, Hainaut P, Thys F| title=Mondor disease: a case report in ED. | journal=Am J Emerg Med | year= 2012 | volume= 30 | issue= 7 | pages= 1325.e1-3 | pmid=21855258 | doi=10.1016/j.ajem.2011.06.031 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21855258}}</ref> and breast trauma. | ||
===Differentiating Mastitis from other diseases=== | ===Differentiating Mastitis from other diseases=== | ||
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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, such as galactocele[1][2], breast engorgement[3][4] [5], mastodynia[6][7][8], fibrocystic breast disease, breast cancer, fibroadenoma, mondor's disease[9][10] and breast trauma.
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. [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.
Mastodynia
Mastalgia may be cyclic or noncyclic with menstruation. There should be no symptoms or signs of breast inflammation. [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.
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.
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.
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. 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.[9] [10]
Diabetes
May manifest with one or more hard, irregular, mobile, discrete, painless, palpable masses.
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. A history of prior trauma, skin biopsy, or a surgical wound in the mammary region may be reported.
Hidradenitis suppurativa
Presents mainly around hair follicles in the axilla and intertriginous regions under the breasts.
Costochondritis
There is localized sternal pain, often exacerbated with respiration or activity.
Neonatal breast hypertrophy
Benign breast enlargement may be transient. The breast bud in such cases is not red or tender.
Gigantomastia
Massive hypertrophy of the breasts may occur early in pregnancy.
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
- ↑ 1.0 1.1 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.
- ↑ 2.0 2.1 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.
- ↑ 3.0 3.1 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.
- ↑ 4.0 4.1 Leung SS (2016). "Breast pain in lactating mothers". Hong Kong Med J. doi:10.12809/hkmj154762. PMID 27313273.
- ↑ 5.0 5.1 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.
- ↑ 6.0 6.1 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.
- ↑ 7.0 7.1 Songtish D, Akranurakkul P (2015). "Mastalgia: Characteristics and Associated Factors in Thai Women". J Med Assoc Thai. 98 Suppl 9: S9–15. PMID 26817204.
- ↑ 8.0 8.1 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.
- ↑ 9.0 9.1 Cox EM, Siegel DM (1997). "Mondor disease: an unusual consideration in a young woman with a breast mass". J Adolesc Health. 21 (3): 183–5. doi:10.1016/S1054-139X(97)00044-X. PMID 9283940.
- ↑ 10.0 10.1 Belleflamme M, Penaloza A, Thoma M, Hainaut P, Thys F (2012). "Mondor disease: a case report in ED". Am J Emerg Med. 30 (7): 1325.e1–3. doi:10.1016/j.ajem.2011.06.031. PMID 21855258.