On the 9th day after childbirth the obstetric patient developed high fever up to 38°C. She complains of pain in the right mammary gland. The examination revealed the following: a sharply painful infiltrate can be palpated in the right mammary gland, the skin over the infiltrate is red, subareolar area and nipple are swollen and painful. What is your diagnosis?

Answer options

1. Abscess of the right mammary gland
2. Cancer of the right mammary gland
3. Fibrous cystic degeneration of the right mammary gland
4. Serous mastitis
5. Mastopathy

Explanation

Lactational mastitis is seen far less frequently than in former years. Most are caused by S. aureus and, if hospital-acquired, are likely to be penicillin-resistant. The intermediary is usually the infant; after the second day of life, 50% of infants harbor staphylococci in the nasopharynx. Although ascending infection from a sore and cracked nipple may initiate the mastitis, in many cases the lactiferous ducts will first become blocked by epithelial debris leading to stasis; this theory is supported by the high incidence of mastitis in women with a retracted nipple. Once within the ampulla of the duct, staphylococci cause clotting of milk and, within this clot, organisms multiply. The affected breast, or more usually a segment of it, presents the classical signs of acute inflammation (high fever, pain, sharply painful infiltrate, the skin over the infiltrate is red, subareolar area and nipple are swollen and painful). Early on this is generalized cellulitis but later an abscess will form. Bailey & Love’s short practice of surgery. – 27th edition. – P. 866.