Preliminary Diagnosis: Mastitis

I. What imaging technique is first-line for this diagnosis

  • Breast ultrasound using grayscale and Doppler technique

II. Describe the advantages and disadvantages of this technique for diagnosis of mastitis.

Advantages
  • Can be diagnostic of mastitis, but oftentimes a biopsy is required to distinguish from inflammatory breast carcinoma
  • Optimal technique for guiding breast core biopsy for mastitis, or abscess drainage
  • Shows the changes of infectious and noninfectious mastitis, as well as inflammatory breast carcinoma
  • Grayscale ultrasound shows the skin thickening, edema, and mass like change associated with mastitis and abscess formation
  • Color and power Doppler ultrasound can show the hyperemia of mastitis
  • Ultrasound is relatively inexpensive, does not use ionizing radiation, and can be performed bedside or in the emergency room
Disadvantages
  • Ultrasound is operator and experience dependent

III. What are the contraindications for the first-line imaging technique?

  • Ultrasound has no significant contraindication

IV. What alternative imaging techniques are available?

  • Breast magnetic resonance imaging (MRI) without and with contrast
  • Mammography

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis mastitis.

Breast MRI without and with contrast
Advantages
  • Can be diagnostic of mastitis, but biopsy is usually required to distinguish mastitis from malignancy
  • Can show all of the findings and complications of mastitis, including abscess
  • Precontrast T2 MRI images show edema and fluid collections associated with mastitis
  • Postcontrast breast MRI shows the enhancement of mastitis
  • Excellent imaging tool for evaluating malignancy or finding pathology in dense breasts
  • Does not use ionizing radiation
Disadvantages
  • Expensive
  • Time-consuming
  • Requires significant patient cooperation to minimize motion artifact
Mammography
Advantages
  • Can show the findings of mastitis
  • First-line imaging tool for breast cancer screening
Disadvantages
  • The findings of mastitis on mammography are nonspecific, and ultrasound and biopsy are usually required to make the diagnosis
  • Exposes the patient to ionizing radiation

VI. What are the contraindications for the alternative imaging techniques?

Breast MRI
  • Patients with embedded metallic devices not made of titanium, such as cardiac pacemakers, metallic stents, and other non-MRI approved devices, cannot enter the magnet for imaging.
Mammography
  • Mammography has no significant contraindication.

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