Breast infection. Mammographic and sonographic findings with clinical correlation

To characterize the mammographic, sonographic, and clinical findings of breast infection and to determine characteristics that could help differentiate it from inflammatory breast carcinoma.

The mammograms, sonograms, and clinical records of 21 consecutive patients who had mammography or sonography within 48 hours of presenting with breast infection were retrospectively reviewed. To exclude other causes of breast inflammation, patients were required to have histologic or aspiration results specific for infection.

Twelve of 19 (63%) mammograms were abnormal. Mammographic abnormalities included an irregular mass (6; 32%), focal asymmetric density (2; 11%), diffuse asymmetric density (2; 11%), circumscribed mass (1; 5%), and architectural distortion (1; 5%). Mammographic skin thickening, present in four (21%) patients, was focal in three and diffuse in one patient with primary breast Mycobacterium tuberculosis infection. No abnormally dense lymph nodes were demonstrated. There was no abnormal soft tissue gas. All 11 (100%) sonograms showed heterogeneous masses that contained internal echoes, 5 of these in patients who had normal mammograms. All 21 patients presented with clinical abnormalities, including palpable mass (20; 95%), pain (11; 52%), erythema (11; 52%), warmth (7; 33%), skin thickening or fixation (4; 19%), and breast swelling (3; 14%). One patient was lactating.

Mammographic, sonographic, and clinical abnormalities were usually present with breast infection that could mimic inflammatory carcinoma. However, diffuse mammographic skin thickening, edema, and dense lymph nodes were rare, and when present may prospectively suggest carcinoma or an unusual infection. Early surgical consultation is advised.