A 24-year-old woman, gravida 1, para 1, comes to the emergency department 4 weeks postpartum due to a 3-day history of a painful, swollen right breast. She is exclusively breastfeeding her infant. She reports subjective fevers, chills, and fatigue. Her temperature is (), blood pressure is , and pulse is . Physical examination of the right breast reveals a 4-cm area of marked erythema, induration, and tenderness in the lower outer quadrant. Careful palpation of this area reveals a distinct, centrally fluctuant mass. There is no overlying skin retraction or purulent nipple discharge. Which of the following is the most appropriate next step in management?
- Targeted ultrasound of the right breastAnswer
- BInitiation of oral dicloxacillin therapy
- CDiagnostic mammography
- DImmediate cessation of breastfeeding from the right breast
- ECore needle biopsy of the mass
Answer
Targeted ultrasound of the right breast
The patient's presentation of fever, localized breast erythema, and a fluctuant mass in the setting of lactation is highly suggestive of a breast abscess. The most appropriate next step in management is a targeted ultrasound of the breast. Ultrasound is the imaging modality of choice to confirm the presence of a fluid collection, differentiate it from severe mastitis without an abscess, and directly guide the first-line intervention, which is typically image-guided needle aspiration.
Step-by-Step Solution
Key Concept
Diagnosis and management of lactational breast abscess