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Puerperal mastitis

 Puerperal mastitis refers to mastitis occurring during pregnancy and lactation.

Epidemiology

It occurs most often during breast feeding and is rarely encountered during pregnancy.

Pathology

The source of infection is the nursing infants nose and throat; the organisms being Staphylococcus aureus and Streptococcus. Due to a breach in the nipple areola complex such as a cracked nipple, there is rerograde dissemination of these normal oro nasal commensals. This is further favoured by stasis of milk as stagnant milk is an excellent medium for bacterial growth.

Staphylococcus aureus infections tend to be more invasive and localised leading to earlier abscess formation; while Streptococcus infections tend to present as diffuse mastitis with focal abscess formation in advanced stages.

Sub types
  • endemic/sporadic - majortiy of the cases
  • epidemic type - less common. Can be life threatening and is related to methicillin resistant Staphylococcus aureus 

Radiographic features

Mammography
  • not ususally done
  • skin and trabecular thickening due to breast edema
  • abscess may be seen as ill defined mass 
Ultrasound
  • primary modality of choice
  • abscess - irregular, hypoechoic to anechoic mass with fluid and debris and posterior acoustic enhancement.
  • mastitis - ill defined, hypoechoic region
  • periductal inflammation
  • guidance for abscess drainage

Treatment

  • antibiotic therapy 
  • drainage of abscess

Differential diagnoisis

Neoplasm should be suspected if the condition does not improve with antibiotic therapy.

See also

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