Inflammatory and infectious diseases of the breast: diagnosis and intervention

Background: Breast infection and inflammation is a common concern in diagnostic breast imaging. These cases may post challenges to the breast imaging radiologist as many of these conditions can resemble malignancy. To best care for these patients and guide percutaneous interventions, a complete understanding of the common clinical presentations of the various inflammatory and infectious entities, epidemiology and pathophysiology is required.

Learning Objectives: 1. List the most common breast emergencies and differentiate the likely cause of symptoms based on clinical history and physical examination findings.
2. Develop a safe approach to the management and diagnosis of inflammatory and infectious breast diseases.
3. Understand the role of percutaneous drainage and/or biopsy in management of breast infection and the steps that can be taken to reduce complications and improve outcomes.

Abstract Content/Results: This educational exhibit will review the epidemiology, pathophysiology, and approach to diagnosis of various inflammatory and infectious diseases of the breast including cellulitis, mastitis, and breast abscess (puerperal and non-puerperal infections). Both the common causative agents (ie. Staphylococcus aureus) as well some uncommon agents (Aspergillosis and Mycobacterium tuberculosis) will be covered through illustrative cases with histopathology correlation. Additional entities including granulomatous mastitis, infected dermal lesions, diabetic mastopathy, mammary duct ectasia/plasma cell mastitis and finally inflammatory breast carcinoma will also be covered with supporting clinical images and illustrative cases. We provide tips and tricks for successful intervention in this patient population with a review of potential complications including milk duct fistula and the consent process for intervention in a lactating breast.

Conclusion: Inflammatory and infectious diseases of the breast present a unique challenge to the breast imaging radiologist and a thorough clinical history and physical examination are key components to the diagnostic workup in this patient population. After initial assessment, skillful breast intervention is commonly required both for diagnostic as well as therapeutic purposes in this population.