Breast abscess: The Daily PANCE Blueprint

Home Breast abscess: The Daily PANCE Blueprint

Breast abscess: The Daily PANCE Blueprint

A 30-year-old female presents with a painful lump on her right breast x 2 days. She had been diagnosed with lactational mastitis recently and was placed on antibiotics. She is normotensive (SBP 120s), febrile (T 101.8F), and tachycardic (HR 102 bpm). On exam, you notice a fluctuant tender mass on the lateral part of the right breast, as well as erythematous and warm skin surrounding the area. There is also a spot of skin over the mass that is blackish and thin. What is the best management for this patient?

A. IV aminoglycosides and Tylenol
B. Warm compresses and supportive care
C. Ultrasound of the breast
D. Surgical incision and drainage
E. CT chest, plus start IV fluid and antibiotics

Answer and topic summary

The answer is D. Surgical incision and drainage

A breast abscess is essentially a localized region of infection/pus in the breast tissue. It is usually seen as a complication of mastitis. Clinical features include breast pain, edema, fever, fluctuant mass, purulent nipple discharge, etc. Diagnosis is often clinical, but a breast ultrasound can be obtained. Treatment includes drainage plus antibiotics (e.g., cephalexin or dicloxacillin). If the patient has risk factors for MRSA, then clindamycin or Bactrim should be given. It’s important to note that surgical incision and drainage is the treatment for breast abscesses complicated by skin necrosis.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Reproductive System ⇒ Breast Disorders ⇒ Breast abscess

Also covered as part of the Women's Health Rotation and Emergency Medicine Rotation topic lists

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