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 10 years ago.
Patient Data
multiple irregular and marginally enhancing thick-walled cystic lesions within the upper inner and outer quadrants as well as retro-areolar and lower central portion of the left breast; the largest is 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 demonstrate low T1 and high STIR signal as well as predominately high T2 signal with some cystic lesions having intermediate T2 signal, denoting variable proteinaceous 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
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 abscesses.
The differential diagnosis of other rim-enhancing breast lesions on MRI:
invasive ductal carcinoma (IDC): non-otherwise specified (NOS).
seroma
ruptured or inflamed cyst
invasive or intracystic papillary carcinoma
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 highly cellular carcinoma with is usually T2 isointense to hypointense
the abscess is most often near the nipple and is tender, palpable and may have erythema. Associated edema on T2WI. May have 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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