Table 3

Ultrasonic characteristics of common pathologies of the lactating breast


Ultrasonic appearances


Margins – well circumscribed with thin smooth walls

Centrally anechoic

Posterior enhancement

Edge shadowing

No internal vascularity


Margins – well defined or occasionally ill-defined

Echogenicity – homogenous to heterogenous

No posterior enhancement unless internal calcification is present

Internal vascularity


Margins – wide, indistinct, hypoechoic

Echogenicity – predominantly echo-free to heterogenous

Posterior enhancement

No internal vascularity


Margins – irregular and ill-defined

Echogenicity – heterogenous echogenicity

Stellate appearance

+/- posterior shadowing

Internal vascularity


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


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)


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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