Puerperal mastitis refers to mastitis occurring during pregnancy and lactation.
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Epidemiology
It occurs most often during breast feeding and is rarely encountered during pregnancy.
Pathology
The source of infection is the nursing infant's nose and throat; the organisms being Staphylococcus aureus and Streptococcus spp. Due to a breach in the nipple-areola complex, such as a cracked nipple, there is retrograde dissemination of these normal commensals. This is further favored by stasis of milk as stagnant milk is an excellent medium for bacterial growth.
Staphylococcus aureus infections tend to be more invasive and localized leading to earlier abscess formation; while Streptococcus infections tend to present as diffuse mastitis with focal abscess formation in advanced stages.
Subtypes
endemic/sporadic: majority of the cases
epidemic type: less common; can be life-threatening and is related to methicillin-resistant Staphylococcus aureus (MRSA)
Radiographic features
Mammography
not usually 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 and prognosis
antibiotic therapy
drainage of abscess
Differential diagnosis
Neoplasm should be suspected if the condition does not improve with antibiotic therapy.
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