Puerperal interstitial mastitis

Case contributed by Dr Ibrahim M. Jubarah

Presentation

Lactating lady, presented with gradually progressive left breast pain since about 5 days.

Patient Data

Age: 35 years
Gender: Female
Ultrasound

The affected side (left side here) show diffuse, relatively ill-defined, echogenic breast fat tissue and increased color flow Doppler, and enlarged lymph nodes in the axilla, with no evidence of focal skin thickening or traction, well-defined mass, or nearby extra-breast tissue invasion.

The dilated lactiferous ducts are of similar appearance bilaterally, without evidence of wall thickening or internal echogenic component or debris.

Comparison of the normally appearing,  non-affected (right side here) breast and axilla demonstrate the difference in echogenicity, architecture, axillary lymph nodes, (shown), and vascularity (right side not shown).

Case Discussion

Features are of inflammatory evidence of lactating breast interstitium, without affection of lactiferous ducts, or evidence of definite neoplastic process,  which along with the clinical features, are representing puerperal interstitial mastitis.

Follow up after the period of conservative management if no improvement, which could be due to insufficient treatment, is required to rule out the potential complication of abscess formation, or the less likely possibility of underlying inflammatory breast cancer

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