A complex, fluid-predominant collection with an echogenic rim and peripheral hyperaemia in an inflamed breast — measure it for aspiration, and follow it to resolution because inflammatory cancer can look the same.
Orient first
- Lactational abscesses are peripheral; non-lactational ones are periareolar (smokers, duct ectasia).
- Idiopathic granulomatous mastitis produces multiple tracking collections.
- Inflammatory breast cancer causes skin thickening and oedema without a drainable collection.
Acquire the study
- High-frequency linear probe over the whole symptomatic breast and axilla; colour Doppler; ultrasound-guided aspiration when a collection is present.
The manoeuvre
- Collection: size in cm in two planes, internal echoes, septation, mobile contents under compression.
- Rim and surrounding tissue: colour Doppler hyperaemia; skin thickness in mm and oedema.
- Sinus tracts toward the skin or nipple.
- Axilla: reactive lymph nodes (cortical thickness in mm).
- After aspiration or antibiotics: follow-up scan until resolution.
What confirms it
- Pus on ultrasound-guided aspiration of a fluid collection.
What licenses you to exclude it
- No fluid component on ultrasound means there is nothing to drain; persistent inflammation needs biopsy to exclude inflammatory cancer.
The classic misread
- Treating inflammatory breast cancer as mastitis — skin oedema without a collection needs biopsy.
- Calling a solid necrotic tumour an abscess.