Ehollywood: /* Clinical Features */

2026-03-06T12:24:31Z

Clinical Features

← Older revision		Revision as of 12:24, 6 March 2026
Line 6:		Line 6:
	* Peripheral - less common (DM, RA, trauma, steroids)		* Peripheral - less common (DM, RA, trauma, steroids)
	* Skin		* Skin
	Pathogens: staphylococcus aureus (MRSA incidence increasing), enterococci, bacteroides, strep pyogenes		''Pathogens:'' staphylococcus aureus (MRSA incidence increasing), enterococci, bacteroides, strep pyogenes

	==Clinical Features==		==Clinical Features==
	Erythema		*Erythema
	Warmth		*Warmth
	Tenderness		*Tenderness
	Fluctuant localized mass		*Fluctuant localized mass
	+/- Fever		*+/- Fever
	Risk factors: smoking, obesity		*Risk factors: smoking, obesity

	==Differential Diagnosis==		==Differential Diagnosis==
Line 29:		Line 29:

	===Diagnosis===		===Diagnosis===
	Clinical diagnosis		*Clinical diagnosis
	POCUS to evaluate for fluid pocket vs cellulitic changes		*POCUS to evaluate for fluid pocket vs cellulitic changes OR formal US
	Formal breast US if malignancy concern		*Formal breast US if malignancy concern

	==Management==		==Management==
	Drainage:		Drainage:
	* Needle aspiration		'''Needle aspiration'''
	- Safe in the ED if no signs of necrosis/ ischemic skin		* Safe in the ED if no signs of necrosis/ ischemic skin
	- Anesthetize with lidocaine 1% with epi		* Anesthetize with lidocaine 1% with epi
	- Can use 18g needle to aspirate		* Can use 18g needle to aspirate
	- Send aspirate for culture to tailor antibiotics		* Send aspirate for culture to tailor antibiotics
	* Surgical		'''Surgical'''
	- Failure to respond to I&D in the ED		*Failure to respond to I&D in the ED
	- Signs of skin ischemia/ necrosis or complex abscess		* Signs of skin ischemia/ necrosis or complex abscess
	- Non responsive to antibiotics		* Non responsive to antibiotics

	Antibiotics		'''Antibiotics'''
	Outpatient
			''Outpatient''

	No MRSA risk factors:		No MRSA risk factors:
	- Dicloxacillin 500mg QID OR		* Dicloxacillin 500mg QID OR
	- Cephalexin 500mg QID OR		* Cephalexin 500mg QID OR
	- beta lactam allergy: Clindamycin 300-450mg TID		* beta lactam allergy: Clindamycin 300-450mg TID
	MRSA risk		MRSA risk
	- Trimethoprim-sulfamethoxazole DS 1-2 tabs BID		* Trimethoprim-sulfamethoxazole DS 1-2 tabs BID
	~~- Clindamycine~~ 300-450mg TID		* Clindamycin 300-450mg TID
	Inpatient
			''Inpatient''
	- Vancomycin IVPB		- Vancomycin IVPB

	Needs follow up in 2-3 days for wound check (sometimes needs to be re-drained)		Needs follow up in 2-3 days for wound check (sometimes needs to be re-drained)
	Referral to breast specialist (breast surgeon,		Referral to breast specialist (breast surgeon)

	~~Harbor UCLA breast abscess pathway~~

			Harbor UCLA breast abscess pathway

	==Disposition==		==Disposition==

Ehollywood: Created page with "==Background== Can occur in both lactating and nonlactating If breastfeeding, typically starts as mastitis and progresses to abscess Types of nonlactational (central, peripheral or skin) * Central - periductal mastitis * Peripheral - less common (DM, RA, trauma, steroids) * Skin Pathogens: staphylococcus aureus (MRSA incidence increasing), enterococci, bacteroides, strep pyogenes ==Clinical Features== Erythema Warmth Tenderness Fluctuant localized mass +/- Fever..."

2026-03-03T22:12:06Z

Created page with "==Background== Can occur in both lactating and nonlactating If breastfeeding, typically starts as mastitis and progresses to abscess Types of nonlactational (central, peripheral or skin) * Central - periductal mastitis * Peripheral - less common (DM, RA, trauma, steroids) * Skin Pathogens: staphylococcus aureus (MRSA incidence increasing), enterococci, bacteroides, strep pyogenes ==Clinical Features== Erythema Warmth Tenderness Fluctuant localized mass +/- Fever..."

New page

==Background==
Can occur in both lactating and nonlactating
If breastfeeding, typically starts as mastitis and progresses to abscess
Types of nonlactational (central, peripheral or skin)
* Central - periductal mastitis
* Peripheral - less common (DM, RA, trauma, steroids)
* Skin
Pathogens: staphylococcus aureus (MRSA incidence increasing), enterococci, bacteroides, strep pyogenes

==Clinical Features==
Erythema
Warmth
Tenderness
Fluctuant localized mass
+/- Fever
Risk factors: smoking, obesity

==Differential Diagnosis==
* Mastitis
* Cellulitis
* Malignancy (i.e inflammatory breast cancer)
* Clogged duct
* Galactocele

==Evaluation==
===Workup===
* Blood cultures if septic
*

===Diagnosis===
Clinical diagnosis
POCUS to evaluate for fluid pocket vs cellulitic changes
Formal breast US if malignancy concern

==Management==
Drainage:
* Needle aspiration
- Safe in the ED if no signs of necrosis/ ischemic skin
- Anesthetize with lidocaine 1% with epi
- Can use 18g needle to aspirate
- Send aspirate for culture to tailor antibiotics
* Surgical
- Failure to respond to I&D in the ED
- Signs of skin ischemia/ necrosis or complex abscess
- Non responsive to antibiotics

Antibiotics
Outpatient
No MRSA risk factors:
- Dicloxacillin 500mg QID OR
- Cephalexin 500mg QID OR
- beta lactam allergy: Clindamycin 300-450mg TID
MRSA risk
- Trimethoprim-sulfamethoxazole DS 1-2 tabs BID
- Clindamycine 300-450mg TID
Inpatient
- Vancomycin IVPB

Needs follow up in 2-3 days for wound check (sometimes needs to be re-drained)
Referral to breast specialist (breast surgeon,

Harbor UCLA breast abscess pathway

==Disposition==

==See Also==

==External Links==

==References==
Dixon, J Michael. “Primary Breast Abscess.” UpToDate, 11 Dec. 2024, www.uptodate.com/contents/primary-breast-abscess.
Losifescu, Sarah. “Mastitis and Breast Abscesses.” emDocs, 5 Aug. 2020, www.emdocs.net/mastitis-and-breast-abscesses/.

Breast abscess - Revision history

Ehollywood: /* Clinical Features */