A 20-year-old woman on the 10th day after her discharge from the maternity ward developed fever up to 39°C and pain in her left mammary gland. On examination the mammary gland is enlarged, in its upper outer quadrant there is a hyperemic area. In this area a dense spot with blurred margins can be palpated. The patient presents with lactostasis and no fluctuation. Lymph nodes in the right axillary crease are enlarged and painful. Specify the correct diagnosis:

Answer options

1. Dermatitis
2. Erysipelas
3. Abscess
4. Lactational mastitis
5. Tumor

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.