ECR 2010 / C-0453
Inflammatory breast disease: Radiologic findings, clinical manifestation and US-guided treatment
Congress:
ECR 2010
Poster Number:
C-0453
Type:
Educational Exhibit
Keywords:
Breast
Authors:
S. H. Park1, E.-K. Kim2, M. J. Kim2, J. Y. Kwak2, S. J. Kim2; 1Incheon/KR, 2Seoul/KR
DOI:
10.1594/ecr2010/C-0453
Imaging findings OR Procedure details
- Ultrasonography is being used to diagnose breast abscesses.
- HR real-time US is unique means for diagnosis and evaluating the extent, size, site and internal characteristics of breast abscess
- A high rate of success (>90%) are reported with percutaneous aspiration and careful irrigation of breast abscesses.
- US guided aspiration of breast abscesses with placement of indwelling catheters has become the treatment of choice.
Fig.: 3. 37 years-old female with large abscess in her left breast.
10F pig-tail catheter(thin arrows) insertion was done under US guidance. 8 days later,on follow-up US, previous abscess(star) was markedly decreased after catheter insertion. After one month, previous abscess pocket near completely disappeared.
III. Tuberculosis of breast
Clinical findings
- Secondary in most patients -Primary breast Tb: rare as the primary manifestation
- Exclusively in females, as many as 4.5% in males
- Reproductive age group, especially during lactation
- 50~70% patients with involvement of axillary nodes
- Retrograde lymphatic spreadfrom axillary nodes or occasionally from cervical or mediastinal nodes
- Insidious onset, painless lump
- Most common in UOQ due to frequent extension from axillary LNs
- Difficulty in its clinical manifestation from breast cancer
Radiological findings
- Mammography: nonspecific findings
- Mimicking carcinoma on mammogram -Nodular, Diffuse, Sclerosing form
- Often With axillary lymphadenopathy
- Suspected bony changes in the thorax
- Hypoechoic fistulous tract on US
- Confirmation by imaging-guided FNA biopsy and culture
Fig.: 4-a. 51 years-old female with palpable mass in RLOQ(a:mammogram). Mammography(Rt.MLO view) showed enlarged lymph nodes with multiple dense calcifications in right axilla.
Fig.: 4-b. 51 years-old female with palpable mass in RLOQ area.(b: US and chest CT)
US revealed large anechoic mass(star) posterior to retroglandular tissue. In chest CT, necrotic mass with well-enhancing wall seen at right anterior chest wall and pleural space, around the right 5th anterior rib. Adjacent linear pleural calcification is seen.
IV. Granulomatous mastitis
Clinical findings
- Very rare inflammatory disease of unknown origin that can clinically mimic carcinoma
- Etiology: unknown
- Possible cause: immunologic factors, oral contraseptives, reaction to childbirth
Diagnosis
- Depend on the demonstration of a particular histologic pattern with exclusion of other granulomatous reactions such as sarcoidosis, Wegener’s granulomatosis, Tb and fungal infection etc.
Clinical manifestation
- Breast lump: distinct, firm to hard mass
- Typically affects younger women(4th decades), <6yrs of pregnancy
- Relationship to pregnancy or lactation has been strongly emphasized
- Reactive axillary lymphadenopathy : up to 15% of patients
Radiologic findings
Mammography
- Focal asymmetry : m/c finding
- Mass with irregular margins
- Normal findings
US
- Inhomogeneous hypoechogenicity with internal hypoechoic tubular structures
Fig.: 5. 21 years-old female with left palpable mass for 5 months.
US showed irregular shaped, heterogeneously hypoechoic lesions.
US-guided 14G core needle biopsy was done. Pathology was confirmed to be granulomatous mastitis.
Fig.: 6-a. 50 years-old female with two palpable mass in her left breast. Mammography was heterogeneously dense breasts with negative findings.
Fig.: 6-b. 50 years-old female with two palpable mass in her left breast.
US showed one isoechoic(5H dierction) and the other hypoechoic(2H) well-circumscribed oval shaped nodules. With biopsy, the nodules were confirmed to be granulomatous mastitis.(6-a:mammography. 6-b:US)
V. Parasitic infection - Sparganosis of breast
Incidence
- Sparganosis >> cysticercosis, norcadiasis
Sparganosis of breast
- Sparganosis of breast
- Few cases reported
Mammography of sparganosis in breast
- Amorphous, lobular, marginated solid mass
- Usually located in subcutaneous tissue
- Mimic mastitis or cancer
US findings of sparganosis in breast
- Heterogeneously hyperechoic masses → granuloma containing living worm
- Internal hypoechoic tubular lesion → empty tract of migrating larval worm
- Tunnel formation is quite distinguishable from cysticercosis and other disease
Fig.: 7-a. 62 years-old female with movable soft palpable mass in LUOQ. Mammography showed lobular shaped, circumscribed marginated, hyperdense solid mass in LUOQ.