eMedicine Specialties > Emergency Medicine > Infectious Diseases

Breast Abscess and Masses: Differential Diagnoses & Workup

Author: Andrew C Miller, MD, Chief Resident and Clinical Assistant Instructor, Departments of Emergency Medicine and Internal Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center
Coauthor(s): Tajinderpal S Saraon, MD,, Chief Resident, Department of Internal Medicine, State University of New York Downstate Medical Center; Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Contributor Information and Disclosures

Updated: Apr 30, 2009

Differential Diagnoses

Abscess
Breast Cancer
Cellulitis
Mastitis

Other Problems to Be Considered

Fibroadenoma
Fibrocystic disease
Fat necrosis
Granulomatous Disease

Workup

Laboratory Studies

  • In patients suspected of having a breast abscess, a CBC with differential may be helpful. An aerobic and anaerobic culture may be taken during surgical drainage.

Imaging Studies

  • Ultrasonography is used to distinguish solid from cystic structures and to direct needle aspiration for abscess drainage. Simple cysts are seen on sonograms as round or oval with sharply defined margins and posterior acoustic enhancement. Complex cysts are characterized by a significant solid component, septations, lobulations, varied wall thickness, and the presence of internal debris. Abscesses usually appear as ill-defined masses and have central hypoechoic areas with either septations or low-level internal echoes, and posterior enhancement.13 For more information, see Breast Cancer, Ultrasonography.
  • Schedule an outpatient mammography to further characterize the suspected breast mass. The sensitivity of mammography ranges from 74-95%, and specificity ranges from 89-99%.14,15  Approximately 5-10% of screening examinations are interpreted as abnormal, but 90% of women with abnormal results do not have breast cancer.14,15 For more information, see Breast, Benign Calcifications, Breast, Fibroadenoma, Breast, Nipple Discharge Evaluation, and Breast Cancer, Mammography. 

Procedures

  • Ultrasound-guided needle aspirations can be performed on abscesses smaller than 3 cm; however, evidence in the literature shows that abscesses greater than 3 cm treated with needle aspiration have a high reoccurrence rate and may need further incision and drainage.16,17,18
  • For many years, I&D has been the standard of care for abscesses. Although I&D has a lower reoccurrence rate, it is more invasive than needle aspiration and frequently results in scarring with poor cosmetic outcomes.19

More on Breast Abscess and Masses

Overview: Breast Abscess and Masses
Differential Diagnoses & Workup: Breast Abscess and Masses
Treatment & Medication: Breast Abscess and Masses
Follow-up: Breast Abscess and Masses
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Dixon JM. ABC of breast diseases. Breast infection. BMJ. Oct 8 1994;309(6959):946-9. [Medline].

  2. Dixon JM. Outpatient treatment of non-lactational breast abscesses. Br J Surg. Jan 1992;79(1):56-7. [Medline].

  3. Whitaker-Worth DL, Carlone V, Susser WS, et al. Dermatologic diseases of the breast and nipple. J Am Acad Dermatol. Nov 2000;43(5 Pt 1):733-51; quiz 752-4. [Medline].

  4. Bland & Copeland. The Breast: Comprehensive Management of Benign and Malignant Disorders. 3rd. Saunders; 2004.

  5. Givens ML, Luszczak M. Breast disorders: a review for emergency physicians. J Emerg Med. Jan 2002;22(1):59-65. [Medline].

  6. Mass S. Breast pain: engorgement, nipple pain and mastitis. Clin Obstet Gynecol. Sep 2004;47(3):676-82. [Medline].

  7. Efrat M, Mogilner JG, Iujtman M, et al. Neonatal mastitis--diagnosis and treatment. Isr J Med Sci. Sep 1995;31(9):558-60. [Medline].

  8. De Silva NK, Brandt ML. Disorders of the breast in children and adolescents, Part 1: Disorders of growth and infections of the breast. J Pediatr Adolesc Gynecol. Oct 2006;19(5):345-9. [Medline].

  9. Anderson WF, Rosenberg PS, Menashe I, Mitani A, Pfeiffer RM. Age-related crossover in breast cancer incidence rates between black and white ethnic groups. J Natl Cancer Inst. Dec 2007;100(24):1804-14. [Medline].

  10. Armstrong K, Eisen A, Weber B. Assessing the risk of breast cancer. N Engl J Med. Feb 24 2000;342(8):564-71. [Medline].

  11. Schafer P, Fürrer C, Mermillod B. An association of cigarette smoking with recurrent subareolar breast abscess. Int J Epidemiol. Dec 1988;17(4):810-3. [Medline].

  12. Brennan M, Houssami N, French J. Management of benign breast conditions. Part 3--Other breast problems. Aust Fam Physician. May 2005;34(5):353-5. [Medline].

  13. Muttarak M, Chaiwun B. Imaging of giant breast masses with pathological correlation. Singapore Med J. Mar 2004;45(3):132-9. [Medline].

  14. Kerlikowske K, Smith-Bindman R, Ljung BM, et al. Evaluation of abnormal mammography results and palpable breast abnormalities. Ann Intern Med. Aug 19 2003;139(4):274-84. [Medline].

  15. Kerlikowske K, Creasman J, Leung JW, et al. Differences in screening mammography outcomes among White, Chinese, and Filipino women. Arch Intern Med. Sep 12 2005;165(16):1862-8. [Medline].

  16. Thirumalaikumar S, Kommu S. Best evidence topic reports. Aspiration of breast abscesses. Emerg Med J. 21(3);May 2004:333-4. [Medline].

  17. Hook GW, Ikeda DM. Treatment of breast abscesses with US-guided percutaneous needle drainage without indwelling catheter placement. Radiology. 1999;213:579-82. [Medline].

  18. Ozseker B, Ozcan UA, Rasa K, Cizmeli OM. Treatment of breast abscesses with ultrasound-guided aspiration and irrigation in the emergency setting. Emerg Radiol. Mar 2008;15(2):105-8. [Medline].

  19. Eryilmaz R, Sahin M, Hakan Tekelioglu M, Daldal E. Management of lactational breast abscesses. Breast. Oct 2005;14(5):375-9. [Medline].

  20. Barbosa-Cesnik C, Schwartz K, Foxman B. Lactation mastitis. JAMA. Apr 2 2003;289(13):1609-12. [Medline].

  21. Zylstra S, D'Orsi CJ, Ricci BA, et al. Defense of breast cancer malpractice claims. Breast J. Mar-Apr 2001;7(2):76-90. [Medline].

  22. American Cancer Society. Breast Cancer Facts & Figures 2007-2008. Available at http://www.cancer.org/downloads/STT/BCFF-Final.pdf. Accessed 04/01/2009.

  23. August DA, Sondak VK. Breast. In: Greenfield LJ, et al, eds. Surgery Scientific Principles and Practice. 2nd ed. Lippincott-Raven Publishers; 1997:1357-1415.

  24. Dener C, Inan A. Breast abscesses in lactating women. World J Surg. Feb 2003;27(2):130-3. [Medline].

  25. Dixon JM. Repeated aspiration of breast abscesses in lactating women. BMJ. Dec 10 1988;297(6662):1517-8. [Medline].

  26. Eley JW, Hill HA, Chen VW, et al. Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA. Sep 28 1994;272(12):947-54. [Medline].

  27. Eryilmaz R, Sahin M, Hakan Tekelioglu M, Daldal E. Management of lactational breast abscesses. Breast. Oct 2005;14(5):375-9. [Medline].

  28. Garcia CJ, Espinoza A, Dinamarca V, et al. Breast US in children and adolescents. Radiographics. Nov-Dec 2000;20(6):1605-12. [Medline].

  29. Harris JR, Lippman ME, Veronesi U, et al. Breast cancer (1). N Engl J Med. Jul 30 1992;327(5):319-28. [Medline].

  30. Houssami N, Ciatto S, Ambrogetti D, Catarzi S, Risso G, Bonardi R, et al. Florence-Sydney Breast Biopsy Study: sensitivity of ultrasound-guided versus freehand fine needle biopsy of palpable breast cancer. Breast Cancer Res Treat. Jan 2005;89(1):55-9. [Medline]. [Full Text].

  31. Karstrup S, Solvig J, Nolsoe CP, et al. Acute puerperal breast abscesses: US-guided drainage. Radiology. 1993;188:807-9. [Medline].

  32. Khoda J, Lantsberg L, Yegev Y, et al. Management of periareolar abscess and mamillary fistula. Surg Gynecol Obstet. Oct 1992;175(4):306-8. [Medline].

  33. Kitchen PR. Management of sub-areolar abscess and mammary fistula. Aust N Z J Surg. Apr 1991;61(4):313-5. [Medline].

  34. Lau SK, McKee GT, Weir MM, Tambouret RH, Eichhorn JH, Pitman MB. The negative predicative value of breast fine-needle aspiration biopsy: the Massachusetts General Hospital experience. Breast J. Nov-Dec 2004;10(6):487-91. [Medline].

  35. Maier WP, Au FC, Tang CK. Nonlactational breast infection. Am Surg. Apr 1994;60(4):247-50. [Medline].

  36. Meguid MM, Oler A, Numann PJ, et al. Pathogenesis-based treatment of recurring subareolar breast abscesses. Surgery. Oct 1995;118(4):775-82. [Medline].

  37. Miller BA, Feuer EJ, Hankey BF. The significance of the rising incidence of breast cancer in the United States. Important Adv Oncol. 1994;193-207. [Medline].

  38. O'Hara RJ, Dexter SP, Fox JN. Conservative management of infective mastitis and breast abscesses after ultrasonographic assessment. Br J Surg. Oct 1996;83(10):1413-4. [Medline].

  39. Walker AP, Edmiston CE, Krepel CJ, et al. A prospective study of the microflora of nonpuerperal breast abscess. Arch Surg. 1988;123:908-11. [Medline].

  40. Watt-Boolsen S, Rasmussen NR, Blichert-Toft M. Primary periareolar abscess in the nonlactating breast: risk of recurrence. Am J Surg. Jun 1987;153(6):571-3. [Medline].

  41. Wiesenfeld HC, Sweet RL. Perinatal infections. In: Scott JR, et al, eds. Danforth's Obstetrics and Gynecology. 7th ed. Lippincott-Raven Publishers; 1994:469.

  42. Surveillance, Epidemiology, and End Results (SEER) Program, SEER 17 Registries, 2000-2004 [database online]. SEER.cancer.gov: Division of Cancer Control and Population Science, National Cancer Institute; 2007.

[ CLOSE WINDOW ]

Further Reading

Clinical guidelines

 Breast cancer screening. American College of Obstetricians and Gynecologists (ACOG). Breast cancer screening. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2003 Apr. 12 p. (ACOG practice bulletin; no. 42). [94 references]

Common breast problems. University of Michigan Health System. Common breast problems. Ann Arbor (MI): University of Michigan Health System; 2007 Oct. 10 p. [7 references]

ACR Appropriateness Criteria® palpable breast masses. Parikh JR, Evans WP, Bassett L, Berg WA, D/Orsi C, Farria DM, Herman CR, Kaplan SS, Liberman L, Mendelson E, Edge SB, Expert Panel on Women's Imaging - Breast. Palpable breast masses. [online publication]. Reston (VA): American College of Radiology (ACR); 2006. 4 p. [30 references]

ACR Appropriateness Criteria® nonpalpable breast masses. D'Orsi CJ, Bassett LW, Berg WA, Bohm-Velez M, Evans WP III, Farria DM, Lee C, Mendelson EB, Goldstein S. Nonpalpable breast masses. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 12 p. [25 references]

[ CLOSE WINDOW ]

Keywords

breast mass, breast lump, breast abscess, breast cancer, mastitis, malignant breast disease, benign breast mass, breast infection, fibrocystic disease, fibroadenoma, malignant breast mass, postpartum mastitis, in situ lobular or ductal cancer, intraductal papilloma, infiltrating ductal carcinoma, inflammatory carcinoma, fibroadenoma

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Andrew C Miller, MD, Chief Resident and Clinical Assistant Instructor, Departments of Emergency Medicine and Internal Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center
Andrew C Miller, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Physicians, American Medical Association, Emergency Medicine Residents Association, Islamic Medical Association of North America, Medical Society of the State of New York, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Tajinderpal S Saraon, MD,, Chief Resident, Department of Internal Medicine, State University of New York Downstate Medical Center
Disclosure: Nothing to disclose.

Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

David FM Brown, MD, Assistant Professor, Department of Medicine, Division of Emergency Medicine, Harvard Medical School; Associate-Chief, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Schering  Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Barry J Sheridan, DO, Chief, Department of Emergency Medical Services, Brooke Army Medical Center
Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.