39-year-old woman with fever and cellulitis of the right breast, recently stopped breastfeeding
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Our first case is a 39-year-old woman who
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presented to the emergency room with fever
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and symptoms of cellulitis of the right
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breast, and we were asked to evaluate
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for an abscess, and interestingly,
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the patient had recently stopped breastfeeding.
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So often our patients that have these acute
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problems are evaluated through the adult, uh,
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emergency department, so they may get, um,
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an ultrasound performed and interpreted by our body
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imaging team rather than breast imaging and, uh,
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sometimes they'll come to us for follow-up later.
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So this was our patient and just scrolling
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through, we can see that the skin is thick.
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So we're starting with.
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Ultrasound, because that's what's
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available in the emergency department.
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So skin thickening, the subcutaneous fat, instead
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of being a medium gray, is kind of a lighter gray
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color, a little bit more echogenic than normal.
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And there's a little bit of fluid
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tracking through the tissue.
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So the tissue's edematous.
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When we put Doppler, color on.
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Um, there's increased vascularity to that tissue.
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And as we get into the tissues,
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there's some more hypoechoic areas, really no
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drainable fluid collection, very vascular.
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See this in the other direction.
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So lots of echogenic fat lobules
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and that very hypervascular
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tissue.
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So that's the right breast.
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They looked at the left breast for comparison.
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And it looks much different, so it doesn't have
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that edema and, um, the vascularity is normal.
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So this was thought to represent
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mastitis without an abscess.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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