Breast abscess: Difference between revisions
Ehollywood (talk | contribs) (Created page with "==Background== Can occur in both lactating and nonlactating If breastfeeding, typically starts as mastitis and progresses to abscess Types of nonlactational (central, peripheral or skin) * Central - periductal mastitis * Peripheral - less common (DM, RA, trauma, steroids) * Skin Pathogens: staphylococcus aureus (MRSA incidence increasing), enterococci, bacteroides, strep pyogenes ==Clinical Features== Erythema Warmth Tenderness Fluctuant localized mass +/- Fever...") |
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* Peripheral - less common (DM, RA, trauma, steroids) | * Peripheral - less common (DM, RA, trauma, steroids) | ||
* Skin | * Skin | ||
Pathogens: staphylococcus aureus (MRSA incidence increasing), enterococci, bacteroides, strep pyogenes | ''Pathogens:'' staphylococcus aureus (MRSA incidence increasing), enterococci, bacteroides, strep pyogenes | ||
==Clinical Features== | ==Clinical Features== | ||
Erythema | *Erythema | ||
Warmth | *Warmth | ||
Tenderness | *Tenderness | ||
Fluctuant localized mass | *Fluctuant localized mass | ||
+/- Fever | *+/- Fever | ||
Risk factors: smoking, obesity | *Risk factors: smoking, obesity | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 29: | Line 29: | ||
===Diagnosis=== | ===Diagnosis=== | ||
Clinical diagnosis | *Clinical diagnosis | ||
POCUS to evaluate for fluid pocket vs cellulitic changes | *POCUS to evaluate for fluid pocket vs cellulitic changes OR formal US | ||
Formal breast US if malignancy concern | *Formal breast US if malignancy concern | ||
==Management== | ==Management== | ||
Drainage: | Drainage: | ||
'''Needle aspiration''' | |||
* Safe in the ED if no signs of necrosis/ ischemic skin | |||
* Anesthetize with lidocaine 1% with epi | |||
* Can use 18g needle to aspirate | |||
* Send aspirate for culture to tailor antibiotics | |||
'''Surgical''' | |||
*Failure to respond to I&D in the ED | |||
* Signs of skin ischemia/ necrosis or complex abscess | |||
* Non responsive to antibiotics | |||
Antibiotics | '''Antibiotics''' | ||
Outpatient | |||
''Outpatient'' | |||
No MRSA risk factors: | No MRSA risk factors: | ||
* Dicloxacillin 500mg QID OR | |||
* Cephalexin 500mg QID OR | |||
* beta lactam allergy: Clindamycin 300-450mg TID | |||
MRSA risk | MRSA risk | ||
* Trimethoprim-sulfamethoxazole DS 1-2 tabs BID | |||
* Clindamycin 300-450mg TID | |||
Inpatient | |||
''Inpatient'' | |||
- Vancomycin IVPB | - Vancomycin IVPB | ||
Needs follow up in 2-3 days for wound check (sometimes needs to be re-drained) | Needs follow up in 2-3 days for wound check (sometimes needs to be re-drained) | ||
Referral to breast specialist (breast surgeon | Referral to breast specialist (breast surgeon) | ||
Harbor UCLA breast abscess pathway | |||
==Disposition== | ==Disposition== | ||
Latest revision as of 12:24, 6 March 2026
Background
Can occur in both lactating and nonlactating If breastfeeding, typically starts as mastitis and progresses to abscess Types of nonlactational (central, peripheral or skin)
- Central - periductal mastitis
- Peripheral - less common (DM, RA, trauma, steroids)
- Skin
Pathogens: staphylococcus aureus (MRSA incidence increasing), enterococci, bacteroides, strep pyogenes
Clinical Features
- Erythema
- Warmth
- Tenderness
- Fluctuant localized mass
- +/- Fever
- Risk factors: smoking, obesity
Differential Diagnosis
- Mastitis
- Cellulitis
- Malignancy (i.e inflammatory breast cancer)
- Clogged duct
- Galactocele
Evaluation
Workup
- Blood cultures if septic
Diagnosis
- Clinical diagnosis
- POCUS to evaluate for fluid pocket vs cellulitic changes OR formal US
- Formal breast US if malignancy concern
Management
Drainage: Needle aspiration
- Safe in the ED if no signs of necrosis/ ischemic skin
- Anesthetize with lidocaine 1% with epi
- Can use 18g needle to aspirate
- Send aspirate for culture to tailor antibiotics
Surgical
- Failure to respond to I&D in the ED
- Signs of skin ischemia/ necrosis or complex abscess
- Non responsive to antibiotics
Antibiotics
Outpatient
No MRSA risk factors:
- Dicloxacillin 500mg QID OR
- Cephalexin 500mg QID OR
- beta lactam allergy: Clindamycin 300-450mg TID
MRSA risk
- Trimethoprim-sulfamethoxazole DS 1-2 tabs BID
- Clindamycin 300-450mg TID
Inpatient - Vancomycin IVPB
Needs follow up in 2-3 days for wound check (sometimes needs to be re-drained) Referral to breast specialist (breast surgeon)
Harbor UCLA breast abscess pathway
Disposition
See Also
External Links
References
Dixon, J Michael. “Primary Breast Abscess.” UpToDate, 11 Dec. 2024, www.uptodate.com/contents/primary-breast-abscess. Losifescu, Sarah. “Mastitis and Breast Abscesses.” emDocs, 5 Aug. 2020, www.emdocs.net/mastitis-and-breast-abscesses/.