Abstract
Newly diagnosed breast abscesses are generally treated as a medical emergency that may necessitate immediate interventional treatment. At our institution, there is no in-house after-hours coverage for breast ultrasonography. We could find no peer-reviewed studies on the cost-effectiveness or clinical management impact of on-call ultrasound technologist coverage for imaging of breast abscesses. The purposes of this study were to determine the incidence of breast abscess in patients with clinical findings highly suggestive of abscess, identify clinical factors associated with breast abscess in such patients, and determine the impact of after-hours emergent or urgent breast ultrasonography on the clinical management of breast abscesses in both outpatients and inpatients. We retrospectively reviewed 100 after-hours breast ultrasound studies performed at our tertiary care center from 2011 to 2015 for evaluation of a suspected breast abscess. Only 26% of our patients with clinically suspected abscess ultimately had a confirmed abscess. Factors associated with breast abscess were a palpable abnormality and a history of breast surgery within the eight weeks before presentation. After-hours diagnosis of an abscess was associated with after-hours clinical intervention. Of the 74 patients in whom after-hours ultrasound imaging showed no evidence of abscess, only three patients underwent after-hours drainage. Our findings support overnight and weekend breast ultrasound coverage in large tertiary care centers.
Highlights
Breast abscesses are collections of infected fluid or pus within the breast and occur primarily as a complication of bacterial infectious mastitis [1,2]
While findings on physical examination such as erythema, tenderness, palpable mass, and fever are considered fairly sensitive in the detection of breast infections, ultrasonography remains the imaging modality of choice [1] to urgently diagnose a breast abscess as it is considered beneficial to triage patients in the emergency department and to influence management in the inpatient setting
Eight-five percent (22/26) of the patients with a confirmed abscess underwent drainage at some time, and 76% (56/74) of the patients without a confirmed abscess did not undergo drainage at any time. In this cohort of 100 patients who underwent after-hours emergent or urgent ultrasonography for evaluation of clinically suspected breast abscesses, we found that the incidence of breast abscess was
Summary
Breast abscesses are collections of infected fluid or pus within the breast and occur primarily as a complication of bacterial infectious mastitis [1,2]. When the infected area of the breast becomes walled off, a breast abscess occurs [1]. There are no universally accepted guidelines for the management of newly diagnosed breast abscesses [3,4], they are generally treated as a medical emergency that may require immediate interventional treatment [5]. While findings on physical examination such as erythema, tenderness, palpable mass, and fever are considered fairly sensitive in the detection of breast infections, ultrasonography remains the imaging modality of choice [1] to urgently diagnose a breast abscess as it is considered beneficial to triage patients in the emergency department and to influence management in the inpatient setting. Every female with inflammatory breast symptoms suggestive of an abscess that fails to resolve with conservative management should receive ultrasound evaluation [2].
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