Multiple breast abcesses

Discussion:

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
  • seroma
  • ruptured or Inflamed Cyst
  • granulomatous mastitis
  • fibrocystic changes
  • invasive or intracystic papillary carcinoma
  • phyllodes tumor
  • angiosarcoma

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.
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