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Subareolar breast abscess are relatively uncommon and tend to occur mostly in young women.
Mastalgia, signs of inflammation, lump formation in the subareolar region and nipple discharge. In chronic cases fistula formation and nipple deformity may be seen. Some risk factors in nonlactating women include nipple piercing, smoking and diabetes1.
Squamous metaplasia of the cuboidal epithelium of the ducts leads to obstruction by keratin plugs. This leads to stasis of the secreted material which in turn leads to duct dilation. Significant dilatation further leads to rupture of the thin columnar epithelial lining and secondary bacterial invastion which leads to the formation of an abscess predominantly in the retroaerolar region.
Retroareolar region or within a centimeter from the areola.
Lower sensitivity in young women with dense breast.
Ultrasound is used most often for detecting abscess. As in other abscesses a fluid collection with irregular walls, contents and hypervascular walls may be seen. Ultrasound can demonstrate a fistulous track formation and may help in guiding abscess drainage.In cases with isolated fistula formation especially with fistulas located in the nipple, sonography failed to reveal any lesions.Also ultrasound probe pressure could be difficult for the patient to tolerate.
However, for patients with isolated fistulas, particularly if the fistulas were located inside the nipples and no masses were palpable, sonography failed to reveal the lesions. The round and irregular surface of the nipple appeared to be an obstacle and prevented a clear sonographic image of the focus inside the nipple and ampulla. Furthermore, pressure from the sonography probe can be too painful for patients with inflammation to tolerate.
Recent studies2 have suggested the role of MRI in imaging of subareolar abscess and demonstration of ducts and intraductal lesions as small as 1 mm. MRI has been proven to demonstrate more details than can ultrasound, like inverted nipples, abscess cavities, fistulas, dilated lactiferous ducts and inflammatory signs. On post contrast enhanced T1 weighted images, the fore mentioned findings were well apprecated.
Treatment and prognosis
Surgical therapy like excision of the lactiferous ducts, affected ampulla and distal diseased ducts and fistula. Reconstruction of the nipple and areola may be needed. Causes prolonged morbidity and has a tendency to recur.