Multiple breast abcesses

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Pain, tenderness and swelling of the left breast since 1 month. The patient is diabetic and cirrhotic with history of operated right breast abscess since 10 years ago.

Patient Data

Age: 45 years
Gender: Female
Modality: MRI

  • multiple irregular and marginally enhancing thick-walled cystic lesions are seen within the upper inner and outer quadrants as well as retro-areolar and lower central portion of the left breast; the largest is seen at the left upper inner quadrant at 10 o'clock position measuring 3 X 2.5 cm as well as at the left upper outer quadrant at 1 o'clock . All these marginally-enhancing cystic lesions are seen demonstrating low T1 and high STIR signal as well as predominately high T2 signal with some cystic lesions are seen with intermediate T2 signal denoting variable proteinacious components.
  • associated parenchymal thickening and enhancement as well as mild diffuse skin thickening with enhancement.
  • dynamic contrast-enhanced MRI of the breasts shows type II time intensity curves with rapid rise followed by plateau.
  • normal entire right breast.
  • bilateral non-specific axillary lymph nodes
Modality: Ultrasound

Multiple irregular hypoechoic and cystic mass lesions with posterior acoustic enhancement. Some of the cysts show peripheral or marginal vascularity.  

Case Discussion

The above described MRI and sonographic findings are consistent with breast abscess

The differential diagnoses of other rim-enhancing breast lesions on MRI:

  • invasive Ductal Carcinoma (IDC): Non-otherwise specified( NOS).
  • medullary Carcinoma
  • seroma
  • ruptured or Inflamed Cyst
  • granulomatous mastitis
  • fibrocystic changes
  • invasive or intracystic papillary carcinoma
  • phyllodes tumor
  • angiosarcoma

The abscess versus infiltrating ductal carcinoma : 

  • the abscess shows prolonged slow intense enhancement, slow washout (plateau or type II time-intensity curve) with non-enhancing central fluid collection. This is in contrary to the DIC with rapid intense rim-enhancement and delayed centripetal enhancement which is highly specific.
  • hyperintense on T2WI and STIR. The carcinoma with packed cellularity is usually T2 isointense to hypointense.
  • the abscess is most often near nipple, tender, palpable and may have erythema. Associated edema on T2WI. May see associated skin thickening (> 2 mm).
  • in equivocal cases: US-guided aspiration/drainage. Follow-up after appropriate antibiotic course may be tried.
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Case Information

rID: 25528
Case created: 28th Oct 2013
Last edited: 16th Dec 2015
System: Breast
Inclusion in quiz mode: Included

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