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Breast Abscess in Lactating Women: US-guided Treatment¹

¹ From the Departments of Radiology (D.U., R.A.C.) and Gynecology and Obstetrics (M.K.G.N.), Karolinska Institute at Danderyds Hospital, S182 88 Danderyd, Sweden. From the 2002 RSNA scientific assembly. Received April 12, 2003; revision requested July 1; revision received December 12; accepted January 30, 2004. Address correspondence to D.U. (e-mail: dieter @swipnet.se).

View larger version (155K): [in a new window]   Figure 1a. Longitudinal US images of US-guided drainage of abscess in lower inner quadrant of right breast in a 27-year-old woman 8 weeks after delivery. (a) Image shows 6 x 4-cm well-defined, slightly lobulated, inhomogeneous hypoechoic abscess. Dots extend across abscess, with cursor at one margin of abscess. (b) Image shows 7-F pigtail catheter containing trocar (arrows) in the abscess cavity. (c) Image obtained after trocar removal and aspiration of 70 mL of pus. Parallel lines represent catheter walls (arrows).

View larger version (157K): [in a new window]   Figure 1b. Longitudinal US images of US-guided drainage of abscess in lower inner quadrant of right breast in a 27-year-old woman 8 weeks after delivery. (a) Image shows 6 x 4-cm well-defined, slightly lobulated, inhomogeneous hypoechoic abscess. Dots extend across abscess, with cursor at one margin of abscess. (b) Image shows 7-F pigtail catheter containing trocar (arrows) in the abscess cavity. (c) Image obtained after trocar removal and aspiration of 70 mL of pus. Parallel lines represent catheter walls (arrows).

View larger version (159K): [in a new window]   Figure 1c. Longitudinal US images of US-guided drainage of abscess in lower inner quadrant of right breast in a 27-year-old woman 8 weeks after delivery. (a) Image shows 6 x 4-cm well-defined, slightly lobulated, inhomogeneous hypoechoic abscess. Dots extend across abscess, with cursor at one margin of abscess. (b) Image shows 7-F pigtail catheter containing trocar (arrows) in the abscess cavity. (c) Image obtained after trocar removal and aspiration of 70 mL of pus. Parallel lines represent catheter walls (arrows).

View larger version (189K): [in a new window]   Figure 2. Longitudinal US image of organized subareolar abscess in left breast of a 28-year-old woman 1 week after delivery. Image shows 3-cm circumscribed, slightly lobulated, inhomogeneous mass. Dots extend across abscess, and cursors define abscess margins. Patient was unable to continue breast-feeding, probably because of mechanical obstruction of the major ducts by this abscess. Abscess was treated with drainage with 6-F catheter (not shown).

View larger version (146K): [in a new window]   Figure 3a. Images of US-guided drainage of superficial breast abscess associated with severe mastitis in upper outer quadrant of left breast in a 24-year-old woman 5 weeks after delivery. (a) Oblique US image shows ill-defined, irregular abscess cavity (arrows). Color Doppler US images (not shown) depicted substantial increased vascularity in surrounding tissue. (b) Oblique US image obtained after percutaneous placement of 8-F lockable pigtail catheter (arrow) into abscess cavity. Catheter was removed 1 day later because of milk leakage around the catheter. (c) Oblique US image shows placement of a 1.7-mm plastic cannula (arrow) that was then used to successfully aspirate the abscess.

View larger version (145K): [in a new window]   Figure 3b. Images of US-guided drainage of superficial breast abscess associated with severe mastitis in upper outer quadrant of left breast in a 24-year-old woman 5 weeks after delivery. (a) Oblique US image shows ill-defined, irregular abscess cavity (arrows). Color Doppler US images (not shown) depicted substantial increased vascularity in surrounding tissue. (b) Oblique US image obtained after percutaneous placement of 8-F lockable pigtail catheter (arrow) into abscess cavity. Catheter was removed 1 day later because of milk leakage around the catheter. (c) Oblique US image shows placement of a 1.7-mm plastic cannula (arrow) that was then used to successfully aspirate the abscess.

View larger version (129K): [in a new window]   Figure 3c. Images of US-guided drainage of superficial breast abscess associated with severe mastitis in upper outer quadrant of left breast in a 24-year-old woman 5 weeks after delivery. (a) Oblique US image shows ill-defined, irregular abscess cavity (arrows). Color Doppler US images (not shown) depicted substantial increased vascularity in surrounding tissue. (b) Oblique US image obtained after percutaneous placement of 8-F lockable pigtail catheter (arrow) into abscess cavity. Catheter was removed 1 day later because of milk leakage around the catheter. (c) Oblique US image shows placement of a 1.7-mm plastic cannula (arrow) that was then used to successfully aspirate the abscess.