Breast Abscess Pathology and Diagnosis

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Questions and Answers

What is a probable cause of a chronic breast abscess?

Absence of predisposing factors

Inadequate treatment of acute abscess (correct)

Good general condition of the patient

Presence of lactation

What is the characteristic of pus in a chronic breast abscess?

Infected pus

Pus with bacteria

Pus with viruses

Sterile pus (correct)

What is the primary investigation for a chronic breast abscess?

Fine Needle Aspiration Cytology (FNAC)

Ultrasonography (U/S) (correct)

Mammography

MRI

What is the most common symptom of chronic breast abscess?

Breast mass with nipple retraction or skin puckering Signup and view all the answers

What is the treatment for chronic breast abscess?

Prophylactic excision Signup and view all the answers

What is a differential diagnosis for chronic breast abscess?

All of the above Signup and view all the answers

What is a distinguishing feature of chronic breast abscess on examination?

Firm, mobile, tender axillary LN Signup and view all the answers

What is the significance of leucocytosis in chronic breast abscess?

Moderate leucocytosis indicates chronic breast abscess Signup and view all the answers

What is the primary goal of using antibiotics in the treatment of breast abscess?

To resolve the underlying infection Signup and view all the answers

What is the medical term for a large sterile brawny edematous swelling that occurs when antibiotics are used in the presence of undrained pus?

Antibioma Signup and view all the answers

What is the recommended approach for breast abscess treatment in cases where repeated aspiration is possible?

Repeated aspiration guided by ultrasound under antibiotic cover Signup and view all the answers

What is the benefit of using repeated aspiration in breast abscess treatment?

It resolves the abscess without the need for incision and drainage Signup and view all the answers

What is the recommended approach for managing breast feeding in cases of breast abscess?

Continue feeding with the healthy breast and evacuate the diseased one Signup and view all the answers

What is the treatment of choice for secondary infections caused by anaerobes in breast abscess?

Metronidazole 400mg four times daily for 5 days Signup and view all the answers

What is the treatment of choice for pre-mammary abscess?

Incision and drainage Signup and view all the answers

What is the recommended approach for draining a retro-mammary abscess?

Incision and drainage through a Thomas incision in the mammary groove Signup and view all the answers

What is the initial treatment for a breast abscess in the early stage?

Evacuation of the breast with a breast pump and hot packs Signup and view all the answers

What is the indication for weaning the child in the treatment of a breast abscess?

Age of the child older than 9 months Signup and view all the answers

What is the purpose of introducing a finger into the abscess during surgical drainage?

To destroy loculi and send pus for C & S Signup and view all the answers

What is the type of incision used for cosmetic purposes in surgical drainage of a breast abscess?

Circum-areolar incision Signup and view all the answers

What is the purpose of performing a U/S in the diagnosis of a breast abscess?

To detect the maturity of the pus loculus and its location Signup and view all the answers

What is the indication for prophylactic antibiotics in the treatment of a breast abscess?

Staphylococcal infection Signup and view all the answers

What is the purpose of painting the nipple with antiseptic cream in the treatment of a breast abscess?

To prevent infection Signup and view all the answers

When should surgical drainage be performed in the treatment of a breast abscess?

Once pus loculus is detected Signup and view all the answers

Study Notes

Chronic Breast Abscess

Inadequate treatment of acute abscess and persistence of predisposing factors (e.g., lactation) contribute to its development.
The abscess contains sterile pus, and organisms are present in the wall.
Clinical features include a mass, pus, and enlarged lymph nodes.
Investigation methods include ultrasound, aspiration, and biopsy.
Excess fibrosis leads to a harder mass, making it difficult to distinguish from malignancy.
Treatment involves prophylactic and curative measures, including excision and antibiotics.

Diagnosis

Attacks of remission and exacerbation are common.
Breast mass may be associated with nipple retraction or skin puckering.
Pus discharge per nipple is a characteristic symptom.
The mass is slightly tender, with a yielding center (Paget test).
Axillary lymph nodes are enlarged, elastic, tender, and mobile.

Differential Diagnosis

Fibro-adenoma and breast carcinoma are potential differential diagnoses.
History of acute abscess and purulent nipple discharge are key distinguishing features.

Management

Aspiration and antibiotics may be used in early stages, with the goal of resolving the abscess without incision.
Antibiotics should not be used in the presence of undrained pus, as this can lead to antibioma.
In cases where the baby is older than 9 months, breastfeeding should be stopped, and Parlodel may be used.

Acute Non-lactational Mastitis

Mastitis neonatorum occurs in full-term infants due to withdrawal of maternal estrogen.
Clinical features include breast enlargement on the 3rd or 4th day, with breast discharge ("witch milk").
Treatment is typically conservative, as the condition is self-limiting.

Mastitis of Puberty

Painful, tender, enlarged breast (unilateral or bilateral) occur in both males and females at 14-15 years.
The condition is self-limiting within 2 years.

Traumatic Mastitis

Caused by ill-fitting bras.
Secondary infection may occur, requiring treatment with metronidazole.

Pre-mammary Abscess

Infection of Montgomery gland (apocrine, sweat gland of breast).
Treatment involves incision and drainage.

Retro-mammary Abscess

Drainage is achieved through Thomas incision in the mammary groove.

Prophylactic Measures

Good hygiene of the nipple (Panthinol).
After delivery, clean the nipple after suckling with a wet tissue (alcohol-free).
If the nipple is fissured, paint it with antiseptic cream.
If milk engorgement occurs, pump evacuation.

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Description

This quiz covers the causes, symptoms, and diagnosis of chronic breast abscesses, including inadequate treatment, predisposing factors, and laboratory investigations.