Presentation
History of secondary infertility and, a tender left breast upper inner quadrant palpable swelling for 2 years.
Patient Data
A predominantly hypodense, homogeneously mid-level echo-filled and walled-off, relatively well defined unilocular fluid content (<10 ml) with central posterior acoustic enhancement plus subtle lateral edge shadowing is noted within the left breast intramammary region at the upper inner quadrant 10:00 clock position. Accompanying hyper-reflective and posteriorly shadowing punctate calcific foci of sub-centimeter dimensions are chanced as well intrinsically within the mentioned fluid content (more within the internal lateral wall aspects). No overt regional desmoplastic tissue reaction or subcutaneous tissue edema or hypervascularity or axillary lymphadenopathy was noted.
A conspicuously tiny and diffusely hypoechoic lesion (of less than 1 cm in diameter) with indistinct outer margins is visualized ipsilaterally adjacent and extrinsic to the left breast fluid content (aforementioned) and these sonographic features point more in the direction of cold left breast abscess likely primarily attributable to partial intra-ductal obstruction sequelae of early/low-grade ductal carcinoma changes (BIRAD 4c - moderate suspicion for malignancy).
Case Discussion
Microlobulated, indistinctly bordered breast lesions (however subtle they may present) and with characteristic hypoechoic parenchymal reflectivity and non-parallel orientation to the breast tissue planes and any presenting intra-ductal or intra-lesional calcific foci (especially if finely pleomorphic or clustered) within the breast parenchyma, are associated as being features that are suggestive of a malignant process 1,2.
Often, such lesions, if intra-ductal, may result in partial or total ductal obstruction thus forming a fluid build-up which with time, may complicate into an abscess. In this case, during real-time scanning, the region was broadly non-tender and no subcutaneous tissue edema or febrile complaints from the patient was registered. Notable also is the longer period (more than 1 year complain of the swelling) plus the non-inflammatory/infectious changes of the abscess 3, underpins and strengthens the diagnosis more as a cold abscess.
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