The male breast is susceptible to many of the same pathologic processes as the female breast. Many of these conditions have mammographic, ultrasonographic (US), and magnetic resonance imaging findings that allow differentiation between clearly benign conditions and those that require biopsy. Gynecomastia is the most common abnormality of the male breast and has characteristic imaging features that usually allow differentiation from malignancy. Mammography is the initial imaging modality for a clinically suspicious mass. A palpable mass that is occult or incompletely imaged at mammography mandates targeted US. Suspicious or indeterminate masses require biopsy, which can usually be performed with US guidance. Approximately 0.7% of breast cancers occur in men. Men with breast cancer often present at a more advanced stage than do women owing to a delay in diagnosis. Benign breast neoplasms that may occur in men include angiolipoma, schwannoma, intraductal papilloma, and lipoma. Benign nonneoplastic entities that may occur in the male breast include intramammary lymph node, sebaceous cyst, diabetic mastopathy, hematoma, fat necrosis, subareolar abscess, breast augmentation, venous malformation, secondary syphilis, and nodular fasciitis. Familiarity with the salient features of the classic benign male breast conditions will allow accurate imaging interpretation and avoid unnecessary and often invasive treatment. © RSNA, 2013.

Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory condition of the breast, which usually mimics breast carcinoma. The aim of this study was to analyze the clinical features of IGM by identifying a more reliable diagnostic protocol, and evaluating the treatment methods and patient outcomes on follow-up. We performed a retrospective analysis of 46 patients diagnosed with IGM and managed by the same surgical team between 1999 and 2011, at three high-volume hospitals. The median age of the patients was 33 years. The most common symptom was painful breast mass (n = 39), followed by abscess (n = 11). All patients underwent ultrasonography (USG). Mammography (MG) and magnetic resonance imaging (MRI) were also performed in 20 patients (43%) and 17 patients (37%), respectively. The mean size of the lesions was 32.8 ± 8.8 mm and ranged from 15 to 50 mm. Preoperative diagnosis of IGM was established by core needle biopsy (CNB) under USG guidance. Eighteen patients (39%) underwent complete excision of the lesion and 25 (54%) were treated with steroids. Three patients treated with steroids subsequently underwent local excision. The mean follow-up period was 35.4 ± 30.9 months. Eight patients (17%) developed disease recurrence; three of these were successfully treated with steroids, one with surgery, and four with both steroids and surgery. CNB in conjunction with high diagnostic accuracy has a significant role in distinctive diagnosis of IGM and hence, is useful for treatment planning. Treatment can be designated according to the extent and the severity of the disease, and the patient's general health and treatment preferences. Patients with IGM must be closely followed up due to the frequency of disease recurrence.

Subcutaneous trunk abscesses are frequent, and current treatment options generally involve incision. By contrast, the standard care for breast abcesses is ultrasound-guided drainage. The aim of this study was to evaluate the feasibility of ultrasound-guided drainage combined with antibiotics in the treatment of subcutaneous abscesses on the trunk.In this prospective study, 27 patients were treated with ultrasound-guided needle aspiration and oral antibiotics. Follow-up was performed at a 3-6-day interval, and the procedure was repeated if the abscess was not obliterated.Treatment was initially successful in 25 of the 27 participants (93%); two patients went on to surgery. The median time from first treatment to the final control visit was nine days. The 25 patients with initial successful treatment were contacted after a median of 84 days, and six (24%) of these reported recurrence of an abscess at the puncture site. 88% of the patients reported that they were satisfied or very satisfied with ultrasound-guided drainage.Our results indicate that ultrasound-guided drainage combined with antibiotics is feasible in the treatment of small subcutaneous abscesses on the trunk. Ultrasound-guided drainage was well-tolerated, had a high degree of success and short healing times. Additional randomised studies are needed to verify our findings.not relevant.not relevant.

Breast tuberculosis is an uncommon form of entity especially in the infra-mammary area. A 25- year-old female, presented with a lump in the breast and infra-mammary area. She was having off and on fever without any other complaints. There was no positive family history. Primary breast tuberculosis was diagnosed on fine needle aspiration cytology wherein ZN stain for acid fast bacilli was positive. The patient received antitubercular drugs and at 3 month follow up the swelling had resolved and the patient was asymptomatic. Breast tuberculosis is a rare disease with non-specific clinical, radiological, and histological findings. Misdiagnosis is common as biopsy specimens are pauci-bacillary and investigations such as microscopy and culture are frequently negative.

OBJECTIVE.

Breast ultrasound is helpful in the characterization of masses to differentiate benign from malignant disease. The internal echotexture of a mass is an important ultra-sound feature in breast diagnostic workup. This article reviews the imaging and histopathology findings of benign and malignant hyperechoic masses to better recognize these conditions.

CONCLUSION.

Hyperechoic masses are frequently benign, including hematoma, fat necrosis, abscess, and benign neoplasm. Malignant hyperechoic lesions include invasive ductal and invasive lobular carcinoma, lymphoma, and sarcoma. Understanding lesion echotexture in the context of clinical and mammographic findings will help establish appropriate diagnoses for hyperechoic masses.

OBJECTIVE::

To determine the evidenced-base value of prophylactic drainage of subcutaneous wounds in surgery.

METHODS::

An electronic search was performed. Articles comparing subcutaneous prophylactic drainage with no drainage were identified and classified according to their level of evidence. If sufficient randomized controlled trials (RCTs) were included, a meta-analysis was performed using the random-effects model. Fifty-two RCTs were included into the meta-analysis to characterize the overall effect of drains in subcutaneous wounds. We further determined subgroups in regards to specific surgical procedures or characteristics as follows: Caesarian sections (6 RCTs), abdominal wounds (8 RCTs), breast reductions (3 RCTs), breast biopsies (3 RCTs), femoral wounds (3 RCTs), axillary lymph node dissections (5 RCTs), hip (6 RCTs) and knee (7 RCTs) arthroplasties, obesity (7 RCTs), and clean contaminated wounds (5 RCTs). Studies were compared for the following end points: hematoma, wound healing issues, seroma, abscess, and infection.

RESULTS::

The following is the largest meta-analysis of the value of subcutaneous, prophylactic drainage that the authors know of. 52 studies with a total of 6930 surgeries were identified as suitable for this analysis. There are a total of 3495 surgeries in the drain group and 3435 in the no-drain group. Prophylactic subcutaneous drainage offers a statistically significant advantage in our meta-analysis only for 1) the prevention of hematomas in breast biopsy procedures and 2) the prevention of seromas in axillary node dissections. In all other procedures studied, drainage did not offer an advantage.

CONCLUSIONS::

Many surgical operations can be performed safely without prophylactic drainage. Surgeons can consider omitting drains after caesarian section, breast reduction, abdominal wounds, femoral wounds, and hip and knee joint replacement. Furthermore, it should be considered to not place drains prophylactically secondary to a patient being obese. Clean-contaminated wounds also do not appear to benefit from prophylactic drainage. However, placement of drains following a surgical procedure are the individual choice of each surgeon and can be based on multiple factors beyond the type of procedure being performed or the patient's body habitus.

Both neonates of male twins born at 30 weeks and 3 days gestation presented with late-onset sepsis caused by an infection with group B streptococci (GBS), shortly after one another. Although the younger twin recovered with a standard regimen of 10 days penicillin G i.v., the older twin had three recurrent episodes with GBS positive blood cultures. Oropharyngeal, faecal, urine, liquor and breast milk cultures were GBS negative. Using echocardiography and a PET/CT scan, a persistent endovascular focus was discovered. We treated him with penicillin G i.v. for 4 weeks, after which he recovered completely. Another male neonate born at 26 weeks gestation presented with GBS sepsis and developed an erythematous swelling of the right mandibula within 12 hours. Ultrasound revealed parotitis, which is rare in neonates (3.8 per 10,000). Risk factors for parotitis include prematurity, low birth weight and dehydration (i.e., diuretic usage). Parotitis can be complicated by abscess formation.

At ultrasonography (US), purely or predominantly echogenic breast masses are rare. These lesions were once assumed to be benign, but recent data suggest that approximately 0.5% of malignant breast lesions appear echogenic. However, correlation with the mammographic appearance, lesion location, and clinical history allows the need for biopsy to be determined. An echogenic mass that is radiolucent at mammography is benign. An echogenic mass that is not radiolucent at mammography may represent a hematoma, complex seroma, silicone granuloma, abscess, galactocele, or fat necrosis when the appropriate clinical history is present. In these cases, biopsy can usually be avoided. If there is a clinical history of cancer or radiation therapy, biopsy is often indicated to assess for metastasis or angiosarcoma. An echogenic mass in an ectatic duct warrants biopsy to exclude carcinoma. An echogenic skin lesion is most likely benign and can occasionally have peripheral vascularity due to surrounding inflammation. However, a skin lesion with internal vascularity is concerning for metastasis or lymphoma. If there is no suspicious clinical history, suspicious sonographic features or mammographic findings would lead to a recommendation for biopsy. Lesions with nonspecific imaging or clinical features (eg, angiolipoma or pseudoangiomatous stromal hyperplasia) may require biopsy to exclude malignancy.