Table 3

Ultrasonic characteristics of common pathologies of the lactating breast

Pathology

Ultrasonic appearances


Cyst

Margins – well circumscribed with thin smooth walls

Centrally anechoic

Posterior enhancement

Edge shadowing

No internal vascularity


Fibroadenoma

Margins – well defined or occasionally ill-defined

Echogenicity – homogenous to heterogenous

No posterior enhancement unless internal calcification is present

Internal vascularity


Abscess

Margins – wide, indistinct, hypoechoic

Echogenicity – predominantly echo-free to heterogenous

Posterior enhancement

No internal vascularity


Malignancy

Margins – irregular and ill-defined

Echogenicity – heterogenous echogenicity

Stellate appearance

+/- posterior shadowing

Internal vascularity


Galactocele

Acute – anechoic and simple or mainly anechoic with some diffuse echoes and multiloculated.

Sub-acute – contain echoes of mild to moderate intensity

Chronic – diffuse echogenicity ranging from moderate to highly echogenic

Can be simple, multilocular and heterogenous

Possible fat-fluid level

Movement of the contents can be demonstrated by compression with the transducer

Galactoceles are centrally devoid of blood vessels however flow may be demonstrated in the walls – use of colour Doppler can confirm this


Blocked duct

Focal – similar appearances to an acute galactocele, non-compressible.

Diffuse – often an area of increased echogenicity associated with a palpable solid region. Occasionally a hypoechoic rim surrounds a more echogenic central region


Lactating adenoma

Margins – well circumscribed to ill-defined

Echogenicity – hypo-, hyper or isoechoic

Homo- or heterogenous

Posterior enhancement or acoustic shadowing

+/- internal vascularity


Engorgement

Increased echogenicity of the glandular tissue due to the large volume of milk in the breast.

Severe engorgement may exhibit ultrasonic signs similar to mastitis (see below)


Mastitis

Early/acute phase: there may be no discernable ultrasonic changes in echogenicity breast tissues

Skin – thickens and becomes more hyperechoic

Cooper's ligaments and stromal fibrous tissue decrease in echogenicity

Areas of inflammation frequently have increased blood flow

Advanced stages: Skin thickening is prominent

Distinction between different breast tissues disappears

Breast thickness increases


Geddes International Breastfeeding Journal 2009 4:4   doi:10.1186/1746-4358-4-4

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