Synopsis
Diagnose granulomatous mastitis only after representative tissue and microbiological exclusion, manage abscesses and symptoms through a multidisciplinary plan, and avoid unsafe corticosteroids when infection remains possible.
- Granulomatous mastitis is a lobulocentric inflammatory breast disorder that can produce painful masses, sterile or infected abscesses, skin ulceration and draining sinuses.
- Idiopathic granulomatous mastitis is a diagnosis of exclusion; pregnancy-related history and Corynebacterium association are relevant, but tuberculosis, fungi, foreign body and carcinoma must be considered.
- Ultrasound maps collections and sinus tracts, while image-guided core biopsy provides architecture needed to show granulomas and exclude invasive malignancy.
Key red flags
Rapid progression, sepsis, necrotic skin or a mass and oedema that remain suspicious for inflammatory cancer requires urgent breast and surgical assessment.
Investigation priorities
Map masses, collections, oedema and sinus tracts and select aspiration or core targets.
Management branches
A non-lactating patient has recurrent culture-negative breast collections and an irregular inflammatory mass despite two antibiotic courses.
- Reassess for sepsis and inflammatory cancer, map collections with ultrasound and obtain mammography appropriate to age and tissue tolerance.
- Core the solid inflammatory margin and aspirate fluid, alerting pathology and microbiology to possible granulomatous disease before specimens are processed.