Patologia inflamatorie a sânului

Dr Panuța Andrian
KEY COMPONENTS OF THE
BREAST EXAMINATION
• Patient sitting up, facing the examiner, arms to
the side
• Inspection for symmetry, contour, scars, skin
lesions, erythema, nipple inversion
• Palpation of the cervical and supraclavicular
basins
• Palpation of the mass in the upright position
KEY COMPONENTS OF THE
BREAST EXAMINATION
•Patient sitting up, arms above head, touching
•Inspection for dimpling, retraction, protruding
mass
•Patient sitting up, arms on hips, pressing inward
•Inspection for dimpling, retraction, protruding
mass, dimpling, or retraction
KEY COMPONENTS OF THE
BREAST EXAMINATION
•Examination of the nipple including gentle
attempt to express discharge
•Palpation of the mass in the supine position.
•Note size, consistency, borders, fixation, and
location (including clock position and
distance from areola)
KEY COMPONENTS OF THE
BREAST EXAMINATION
• Palpation of the entire breast
parenchyma including inframammary
fold, axillary tail
• Note locations of any additional
masses including size and location
• Examine the opposite breast in same
Mastitis
• Mastitis is an infection of the breast that occurs most
commonly among women who are breast feeding. Three
percent to 10% of lactating women may develop signs or
symptoms of mastitis. Mastitis may be more common in
lactating women who have had a previous episode of
mastitis, women with cracks or sores on their nipple,
older women, and professional women. When mastitis
occurs in lactating women, it is referred to as puerperal
mastitis.
Mastitis
• Nonpuerperal mastitis may also occur as a result of
trauma, possibly fibrocystic disease or sometimes an
unrecognized etiology. Patients typically present with a
hard, warm, red, tender, swollen area of one breast. They
may have associated fever, shakes, chills, myalgia, and
malaise. Staphylococcus aureus is the most common
causative organism but streptococci, coagulase-negative
staphylococci, and Escherichia coli may also be cultured
from infected patients.
MANAGEMENT
History and physical examination should
focus on identifying a likely etiology for the
mastitis, as well as the risk of breast cancer.
The possibility of inflammatory breast
cancer, though unlikely, must be kept in
mind, particularly in women with
nonpuerperal mastitis with no clear etiology.
Some lactating women present with plugged
MANAGEMENT
If no abscess is detected on either physical
examination or ultrasound, then
management is conservative. Antibiotics
(dicloxacillin or cloxacillin, 250 mg orally
four times a day for 10 to 14 days) should
be initiated. Culturing the milk or any
purulent nipple discharge for antibiotic
sensitivities may help guide a change if the
Breast Abscess
Epidermal inclusion cysts can occur in the
skin of the breast because they can occur
anywhere. However, because they often
present as a “breast mass,” they often
invoke a higher degree of anxiety. Epidermal
inclusion cysts are typically subcutaneous
masses fixed to the dermis. Examination
usually reveals an overlying pore and
Breast Abscess
Often these inclusion cysts become infected,
typically with S. aureus. Clinically, this
presents as a tender, warm, erythematous
mass. Patients may report a previous
spontaneous drainage of the cyst with
improvement in symptoms. Management is
aimed at resolution of the acute infection
followed by surgical resection to prevent
Breast Abscess
Peripheral breast abscesses develop in
about 5% to 10% of women with mastitis,
possibly because of a delay in diagnosis or
inadequate therapy. These are different from
the subareolar. abscesses discussed below
(Table 6–1). The presentation is similar to
that of mastitis (pain, erythema, tenderness)
but with a palpable fluctuant mass. There is
Breast Abscess
Management consists of antibiotics and
drainage. However, many of these can be
successfully treated by needle aspiration
rather than incision and drainage.
Ultrasound guidance for the aspiration is
preferred to ensure complete aspiration of
the abscess. When needle aspiration is not
possible, or not effective, incision and
Breast Abscess
Cultures should be obtained. All loculations
should be disrupted and the wound irrigated
with saline. A small sample of the abscess
wall should be sent for pathology study to
rule out cancer, even though this is
extremely unlikely, especially among
lactating women. The wound is packed with
gauze and allowed to heal by secondary
Breast Abscess
Women who are lactating will have
questions regarding continued breast-
feeding. Most antibiotics are safe during
breast-feeding, but this should be confirmed.
Nursing should continue on the opposite
side. If the incision does not interfere with
the ability of the infant to latch on, breast-
feeding may also continue on the affected
•

        Your account was flagged as suspicious by an automated system. If this was an error, please accept our apologies.   Request Unflagging