Multiple breast abcesses
The above described MRI and sonographic findings are consistent with breast abscess.
The differential diagnoses of other rim-enhancing breast lesions on MRI:
- invasive Ductal Carcinoma (IDC): Non-otherwise specified( NOS).
- medullary Carcinoma
- ruptured or Inflamed Cyst
- granulomatous mastitis
- fibrocystic changes
- invasive or intracystic papillary carcinoma
- phyllodes tumor
The abscess versus infiltrating ductal carcinoma :
- the abscess shows prolonged slow intense enhancement, slow washout (plateau or type II time-intensity curve) with non-enhancing central fluid collection. This is in contrary to the DIC with rapid intense rim-enhancement and delayed centripetal enhancement which is highly specific.
- hyperintense on T2WI and STIR. The carcinoma with packed cellularity is usually T2 isointense to hypointense.
- the abscess is most often near nipple, tender, palpable and may have erythema. Associated edema on T2WI. May see associated skin thickening (> 2 mm).
- in equivocal cases: US-guided aspiration/drainage. Follow-up after appropriate antibiotic course may be tried.