Inflammatory Breast Disease

Mastitis

1. Lactational

2. Periductal Mastitis (Zuska Disease)

3. pathogenesis

   • lactational: stagnant milk → microbial growth

4. risk factors

   • lactation

   • smoking

5. microbiology: S. aureus esp. MRSA

6. clinical

   • fever

   • focal tenderness esp. first 3 months breastfeeding

   • focal edema and erythema

7. therapy

   • abx duration 10-14 days

   • non-severe MSSA: either

     1. dicloxacillin 500 mg QID

     2. cephalexin 500 mg QID

   • non-severe MRSA: either

     1. Bactrim 160-800 mg BID

     2. clindamycin 300 mg QID or 450 mg TID

   • severe

     1. vancomycin

   • okay to continue breastfeeding

8. differential

   • plugged duct (palpable lump, tender, no systemic sx)

   • galactocele (fluctuance, non-tender, no systemic sx)

   • idiopathic granulomatous mastitis

   • inflammatory breast cancer

Idiopathic Granulomatous Mastitis (IGM)

1. clinical

   • solid peripheral mass(es)

   • abscess(es)

   • ulcer(s)

   • erythema

2. microbiology: Corynebacterium kroppenstedtii

3. diagnosis: CNB w/non-necrotizing granulomatous tissue

Breast Abscess

1. risk factors

   • mastitis

   • smoking

2. clinical

   • palpable fluctuance

   • otherwise similar to mastitis

3. diagnosis

   • clinical signs

   • US-breast (fluid collection)

4. therapy

   • abx (same as for mastitis) and either

     1. needle aspiration (refer to IR)

        • reduces risk of milk fistula

        • 2-3 aspirations are sufficient in many cases; larger collections may require up to 6

     2. I&D: indicated for skin ischemia/necrosis or refractory cases

Mondor Disease

1. pathogenesis: superficial thrombophlebitis of the breast

2. clinical: thickened tender cord, pain, erythema, edema

3. therapy: self-limited (resolves in 4-6 weeks)

Duct Ectasia

1. TBD

Fat Necrosis

1. TBD

Lymphocytic Mastopathy (Sclerosing Lymphocytic Lobulitis)

1. TBD