Non Lactational Breast Abscess (Peri Ductal Mastitis) скачать в хорошем качестве

Non Lactational Breast Abscess (Peri Ductal Mastitis)

Non-lactational mastitis is the inflammation of the breast tissue in a nulliparous woman or occurring in a breast feeding mother after a minimum of 6 months after cessation of lactation. Periductal mastitis is a chronic non-lactational inflammation around the major milk ducts. The pathogenesis is obscure and thought to be autoimmune in nature. The condition is much more common in smokers. It may progress to a subareolar inflammatory mass that may suppurate, forming a subareolar abscess. Thick areolar muscles do not allow the abscess to perforate through the areola so the pus follows the path of least resistance, rupturing the skin at the areolar edge and forming a milk duct fistula. In some cases, a chronic indurated mass forms beneath the areola, which mimics a carcinoma. Fibrosis in and around major milk ducts causes nipple retraction. The patient presents with central non-cyclical pain, pus discharge from the nipple and a subareolar tender mass/ abscess or mammary duct fistula. The examination reveals a tender, firm subareolar lump or abscess, purulent nipple discharge, thickened tender major milk ducts and a transverse slit-like nipple retraction looking like a fish mouth. Ultrasonography shows thickened major milk ducts with surrounding inflammation or abscess. A lump should be biopsied under ultrasound guidance to confirm the diagnosis. Any pus discharge should be sent for culture sensitivity and Gene Expert for Mycobacterium tuberculosis complex and resistance to rifampicin testing to rule out TB. Many cases of periductal mastitis resolve with a course of antibiotics, combined with needle aspiration of an abscess. However, surgical treatment by major milk duct excision is needed in patients with a subareolar abscess or sepsis and a mammary duct fistula. A 1.5- to 2 cm length of the ductal cone should be excised. Smoking cessation must be encouraged to prevent recurrence.