A Pictorial Review on Mastitis: Clinical Aspects, Imaging Features and Complications

Breast mastitis is a common condition that can be found during clinical practice, challenging the clinician, who must reach the correct diagnosis among the many differentials, to properly treat the underlying pathology. In this review, we aim to provide clinicians and radiologists with an overview of the various forms of mastitis, focusing on clinical presentation, etiological subtypes, imaging appearances across modalities (e.g., ultrasound, mammography/tomosynthesis, contrast enhanced techniques, MRI), related complications, and the typical imaging takeaways. Our goal is also to provide tools for the correct differential diagnosis between various forms of mastitis, breast cancer and other inflammatory breast pathologies. A computerized literature search using PubMed and Google Scholar was performed by authors, entering various keywords (e.g., "mastitis", "breast infections", "breast abscess", "breast cancer mimickers", "lactational mastitis", "non lactational mastitis", "mastitis imaging", "rare forms of mastitis"). Articles published between 2002 and 2025 were taken into consideration. The authors selected various eligible studies, scientific articles and extracted data to cover the whole spectrum of mastitis clinical presentation and underlying pathology. Authors divided the mastitis spectrum into "lactational" and "non-lactational" forms. Between the second group, periductal mastitis, idiopathic granulomatous mastitis, and rarer forms are taken into consideration. Our review has several limitations: it is a narrative and not systematic review and has limited generalizability of rare subtypes because of the case report driven evidence, heterogeneity of selected studies and potential selection bias. It supplies imaging from various clinical cases, which can be useful to familiarize with the pathology spectrum. In conclusion, breast mastitis is a challenge for breast radiologists and clinicians, familiarity with this condition is crucial to make a correct differential diagnosis. Further studies are needed on rarer subtypes.