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Breast
Special Topics
Infections and Inflammation
Mastitis
Mastitis
Lori Strachowski, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Focal or diffuse breast inflammation, usually infectious
              • Includes cellulitis of breast
            • Several distinct clinical entities
              • Puerperal mastitis: In lactating breast; bacterial
              • Nonpuerperal mastitis: Broad category of nonlactational bacterial infection; includes iatrogenic
                • Often categorized as central vs. peripheral
                  • Central/subareolar often includes periductal mastitis, squamous metaplasia of lactiferous ducts (SMOLD)
              • Unusual infections: Mycobacterium (TB), Corynebacterium, fungal, parasites, etc.
              • Periductal mastitis/duct ectasia complex: Inflammation of subareolar ducts, appears to be bacterial
              • SMOLD: Squamous metaplasia of lactiferous ducts; premenopausal smokers
              • Granulomatous mastitis: Noninfective granulomatous inflammatory condition, typically in parous women
              • Lympho(plasma)cytic mastitis: Intense lymphocytic (± plasma cell) infiltrate → fibrosis

          IMAGING

          • General Features

            • Mammographic Findings

              • Ultrasonographic Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Angelopoulou A et al: The microbiology and treatment of human mastitis. Med Microbiol Immunol. 207(2):83-94, 2018
                                        2. Pluguez-Turull CW et al: Idiopathic granulomatous mastitis: manifestations at multimodality imaging and pitfalls. Radiographics. 38(2):330-56, 2018
                                        3. Qiao Y et al: Tuberculosis mastitis presenting as bilateral breast masses. Clin Imaging. 52:28-31, 2018
                                        4. Zhang L et al: Diffusion-weighted imaging in relation to morphology on dynamic contrast enhancement MRI: the diagnostic value of characterizing non-puerperal mastitis. Eur Radiol. 28(3):992-9, 2018
                                        5. Zhang Y et al: Clinical characteristics, classification and surgical treatment of periductal mastitis. J Thorac Dis. 10(4):2420-7, 2018
                                        6. Liu L et al: Periductal mastitis: an inflammatory disease related to bacterial infection and consequent immune responses? Mediators Inflamm. 2017:5309081, 2017
                                        7. Cheng L et al: Mastitis, a radiographic, clinical, and histopathologic review. Breast J. 21(4):403-9, 2015
                                        8. Lepori D: Inflammatory breast disease: the radiologist's role. Diagn Interv Imaging. 96(10):1045-64, 2015
                                        9. Handa P et al: Granulomatous mastitis: changing clinical and imaging features with image-guided biopsy correlation. Eur Radiol. 24(10):2404-11, 2014
                                        10. Mahoney MC et al: Breast emergencies: types, imaging features, and management. AJR Am J Roentgenol. 202(4):W390-9, 2014
                                        11. Alhabshi SM et al: Lymphocytic mastitis mimicking breast carcinoma, radiology and pathology correlation: review of two cases. Malays J Med Sci. 20(3):83-7, 2013
                                        12. Ferris-James DM et al. Imaging approaches to diagnosis and management of common ductal abnormalities. Radiographics. 2012 Jul-Aug;32(4):1009-30
                                        13. Lo G et al: Squamous metaplasia of lactiferous ducts (SMOLD). Clin Radiol. 67(11):e42-6, 2012
                                        14. Xue DQ et al: Risk factors for surgical site infections after breast surgery: a systematic review and meta-analysis. Eur J Surg Oncol. 38(5):375-81, 2012
                                        15. Throckmorton AD et al: Microbiology of surgical site infections complicating breast surgery. Surg Infect (Larchmt). 11(4):355-9, 2010
                                        16. Hovanessian Larsen LJ et al: Granulomatous lobular mastitis: imaging, diagnosis, and treatment. AJR Am J Roentgenol. 193(2):574-81, 2009
                                        17. Paajanen H et al: Does preoperative core needle biopsy increase surgical site infections in breast cancer surgery? Randomized study of antibiotic prophylaxis. Surg Infect (Larchmt). 10(4):317-21, 2009
                                        18. Kvist LJ et al: The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment. Int Breastfeed J. 3:6, 2008
                                        19. Spencer JP: Management of mastitis in breastfeeding women. Am Fam Physician. 78(6):727-31, 2008
                                        20. Araco A et al: Infections of breast implants in aesthetic breast augmentations: a single-center review of 3,002 patients. Aesthetic Plast Surg. 31(4):325-9, 2007
                                        21. Cerveira I et al: Lupus mastitis. Breast. 15(5):670-2, 2006
                                        22. Lee JH et al: Radiologic and clinical features of idiopathic granulomatous lobular mastitis mimicking advanced breast cancer. Yonsei Med J. 47(1):78-84, 2006
                                        23. Nagpal V et al: Breast lump as a presentation of a hydatid disease. Trop Doct. 36(1):57-8, 2006
                                        24. Stricker T et al: Nonpuerperal mastitis in adolescents. J Pediatr. 148(2):278-81, 2006
                                        25. da Silva BB et al: Primary tuberculosis of the breast mimicking carcinoma. Am J Trop Med Hyg. 73(5):975-6, 2005
                                        26. Edey AJ et al: Ductal breast carcinoma presenting with methicillin-resistant Staphylococcus aureus mastitis. Breast J. 11(6):491-2, 2005
                                        27. Lai EC et al: The role of conservative treatment in idiopathic granulomatous mastitis. Breast J. 11(6):454-6, 2005
                                        28. Rosen PP: Rosen's Breast Pathology. Philadelphia: Lippincott Williams & Wilkins. 65-75, 2001
                                        29. Kopans D: Breast Imaging. 2nd ed. Philadelphia: Lippincott-Raven. 523-4, 1998
                                        30. Bassett LW et al: Diagnosis of Diseases of the Breast. Philadelphia: WB Saunders. 382-5, 1997
                                        31. O'Hara RJ et al: Conservative management of infective mastitis and breast abscesses after ultrasonographic assessment. Br J Surg. 83(10):1413-4, 1996
                                        32. Karstrup S et al: Acute puerperal breast abscesses: US-guided drainage. Radiology. 188(3):807-9, 1993
                                        33. Watt-Boolsen S et al: Primary periareolar abscess in the nonlactating breast: risk of recurrence. Am J Surg. 153(6):571-3, 1987
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Pathology

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Definitions

                                                  • Focal or diffuse breast inflammation, usually infectious
                                                    • Includes cellulitis of breast
                                                  • Several distinct clinical entities
                                                    • Puerperal mastitis: In lactating breast; bacterial
                                                    • Nonpuerperal mastitis: Broad category of nonlactational bacterial infection; includes iatrogenic
                                                      • Often categorized as central vs. peripheral
                                                        • Central/subareolar often includes periductal mastitis, squamous metaplasia of lactiferous ducts (SMOLD)
                                                    • Unusual infections: Mycobacterium (TB), Corynebacterium, fungal, parasites, etc.
                                                    • Periductal mastitis/duct ectasia complex: Inflammation of subareolar ducts, appears to be bacterial
                                                    • SMOLD: Squamous metaplasia of lactiferous ducts; premenopausal smokers
                                                    • Granulomatous mastitis: Noninfective granulomatous inflammatory condition, typically in parous women
                                                    • Lympho(plasma)cytic mastitis: Intense lymphocytic (± plasma cell) infiltrate → fibrosis

                                                IMAGING

                                                • General Features

                                                  • Mammographic Findings

                                                    • Ultrasonographic Findings

                                                      • MR Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Gross Pathologic & Surgical Features

                                                                • Microscopic Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Angelopoulou A et al: The microbiology and treatment of human mastitis. Med Microbiol Immunol. 207(2):83-94, 2018
                                                                              2. Pluguez-Turull CW et al: Idiopathic granulomatous mastitis: manifestations at multimodality imaging and pitfalls. Radiographics. 38(2):330-56, 2018
                                                                              3. Qiao Y et al: Tuberculosis mastitis presenting as bilateral breast masses. Clin Imaging. 52:28-31, 2018
                                                                              4. Zhang L et al: Diffusion-weighted imaging in relation to morphology on dynamic contrast enhancement MRI: the diagnostic value of characterizing non-puerperal mastitis. Eur Radiol. 28(3):992-9, 2018
                                                                              5. Zhang Y et al: Clinical characteristics, classification and surgical treatment of periductal mastitis. J Thorac Dis. 10(4):2420-7, 2018
                                                                              6. Liu L et al: Periductal mastitis: an inflammatory disease related to bacterial infection and consequent immune responses? Mediators Inflamm. 2017:5309081, 2017
                                                                              7. Cheng L et al: Mastitis, a radiographic, clinical, and histopathologic review. Breast J. 21(4):403-9, 2015
                                                                              8. Lepori D: Inflammatory breast disease: the radiologist's role. Diagn Interv Imaging. 96(10):1045-64, 2015
                                                                              9. Handa P et al: Granulomatous mastitis: changing clinical and imaging features with image-guided biopsy correlation. Eur Radiol. 24(10):2404-11, 2014
                                                                              10. Mahoney MC et al: Breast emergencies: types, imaging features, and management. AJR Am J Roentgenol. 202(4):W390-9, 2014
                                                                              11. Alhabshi SM et al: Lymphocytic mastitis mimicking breast carcinoma, radiology and pathology correlation: review of two cases. Malays J Med Sci. 20(3):83-7, 2013
                                                                              12. Ferris-James DM et al. Imaging approaches to diagnosis and management of common ductal abnormalities. Radiographics. 2012 Jul-Aug;32(4):1009-30
                                                                              13. Lo G et al: Squamous metaplasia of lactiferous ducts (SMOLD). Clin Radiol. 67(11):e42-6, 2012
                                                                              14. Xue DQ et al: Risk factors for surgical site infections after breast surgery: a systematic review and meta-analysis. Eur J Surg Oncol. 38(5):375-81, 2012
                                                                              15. Throckmorton AD et al: Microbiology of surgical site infections complicating breast surgery. Surg Infect (Larchmt). 11(4):355-9, 2010
                                                                              16. Hovanessian Larsen LJ et al: Granulomatous lobular mastitis: imaging, diagnosis, and treatment. AJR Am J Roentgenol. 193(2):574-81, 2009
                                                                              17. Paajanen H et al: Does preoperative core needle biopsy increase surgical site infections in breast cancer surgery? Randomized study of antibiotic prophylaxis. Surg Infect (Larchmt). 10(4):317-21, 2009
                                                                              18. Kvist LJ et al: The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment. Int Breastfeed J. 3:6, 2008
                                                                              19. Spencer JP: Management of mastitis in breastfeeding women. Am Fam Physician. 78(6):727-31, 2008
                                                                              20. Araco A et al: Infections of breast implants in aesthetic breast augmentations: a single-center review of 3,002 patients. Aesthetic Plast Surg. 31(4):325-9, 2007
                                                                              21. Cerveira I et al: Lupus mastitis. Breast. 15(5):670-2, 2006
                                                                              22. Lee JH et al: Radiologic and clinical features of idiopathic granulomatous lobular mastitis mimicking advanced breast cancer. Yonsei Med J. 47(1):78-84, 2006
                                                                              23. Nagpal V et al: Breast lump as a presentation of a hydatid disease. Trop Doct. 36(1):57-8, 2006
                                                                              24. Stricker T et al: Nonpuerperal mastitis in adolescents. J Pediatr. 148(2):278-81, 2006
                                                                              25. da Silva BB et al: Primary tuberculosis of the breast mimicking carcinoma. Am J Trop Med Hyg. 73(5):975-6, 2005
                                                                              26. Edey AJ et al: Ductal breast carcinoma presenting with methicillin-resistant Staphylococcus aureus mastitis. Breast J. 11(6):491-2, 2005
                                                                              27. Lai EC et al: The role of conservative treatment in idiopathic granulomatous mastitis. Breast J. 11(6):454-6, 2005
                                                                              28. Rosen PP: Rosen's Breast Pathology. Philadelphia: Lippincott Williams & Wilkins. 65-75, 2001
                                                                              29. Kopans D: Breast Imaging. 2nd ed. Philadelphia: Lippincott-Raven. 523-4, 1998
                                                                              30. Bassett LW et al: Diagnosis of Diseases of the Breast. Philadelphia: WB Saunders. 382-5, 1997
                                                                              31. O'Hara RJ et al: Conservative management of infective mastitis and breast abscesses after ultrasonographic assessment. Br J Surg. 83(10):1413-4, 1996
                                                                              32. Karstrup S et al: Acute puerperal breast abscesses: US-guided drainage. Radiology. 188(3):807-9, 1993
                                                                              33. Watt-Boolsen S et al: Primary periareolar abscess in the nonlactating breast: risk of recurrence. Am J Surg. 153(6):571-3, 1987
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