Pregnancy and lactation: physiologic, paraphysiologic and pathologic breast changes.

Congress:

ECR 2011

Poster Number:

C-1557

Type:

Educational Exhibit

Keywords:

Breast, Obstetrics (Pregnancy / birth / postnatal period), Ultrasound

Authors:

R. Scandiffio, C. Giaconi, A. Cilotti, C. Marini, D. Mazzotta, M. Moretti, D. Caramella; pisa/IT

DOI:

10.1594/ecr2011/C-1557

DOI-Link:

https://dx.doi.org/10.1594/ecr2011/C-1557

Fig. 1: US in a 34 years old woman in 28 weeks of pregnancy. US depicts hyperechoic...

Fig. 2: Warm, tender swelling in a 32 years old woman in pregnancy. US shows a big,...

Fig. 3: Hard swelling in lower quadrants on left breast, in a 36 years old woman, at...

Learning objectives

To evaluate physiological changes and abnormal findings during pregnancy and lactation.

Background

Breast parenchyma undergoes important physiologic changes during pregnancy and lactation. Hormonal modification leads to a change into parenchymal architecture from the 1st trimester of pregnancy; arising values of estrogen, progesterone and prolactin lead to ductular thickenig, lobular growth, increasing in vascularity and involution of fibrofatty composition. In the 2nd and 3rd trimester, lobular growth is particularly marked, cytological changes become clear and alveolar cells differentiate into a more specialized colostrum-cell epithelium. Hormonal changes, milk production and traumatic damage to nipple during lactation explain inflammatory, infectious...

Imaging findings OR Procedure details

Gestational and secretory hyperplasia are normal findings during pregnancy and lactation; breast is characterized by ductal sprouting, lobular growth and decrease of intraglandular fat. At mammography, breast parenchyma appears dense and confluent, while fat tissue decreases; in lactating women, mammography should be performed after breast- feeding. At ultrasonography, echogenity in lactating breast parenchyma becomes more marked as more milk is synthesised. Milk ducts present hypoechoic and can contain flecks representing milk fat globules; echogenic wall can be visible; medium diameter is 2mm with a wide...

Conclusion

During pregnancy and lactation, breast undergoes important changes; pathologies are the same observed in non- pregnancy women, but can present peculiar findings. US is the first exam to perform, and it is usually helpful.

Personal Information

References

[1] Radiologic evaluation of breast disorders related to pregnancy and lactation. Sabate JM, Clotet M, Torrubia S, Gomez A, Guerrero R, de las Heras P, Lerma E. Radiographics. 2007 Oct;27 Suppl 1:S101-24. Review [2] The use of ultrasound to identify milk ejection in women - tips and pitfalls. Geddes DT. Int Breastfeed J. 2009 Jun 1;4:5. [3] The lactating breast: contrast-enhanced MR imaging of normal tissue and cancer. Espinosa LA, Daniel BL, Vidarsson L, Zakhour M, Ikeda DM, Herfkens RJ. Radiology. 2005 Nov;237(2):429-36. [4] Lactating...