Please evaluate the right breast, upper lateral area for abscess/signs of soft tissue infection. Patient is admitted for abscess, unclear source. She has area of mild induration and redness in the right upper lateral area approximately 10:00 position from the areola. On physical examination, a superficial skin ulcer (patient has a habit of picking herself) in the right breast medially approximately 4:00 position, 5 cm from the nipple. A 3 cm mobile palpable lump is identified in the right breast 10:00 position, 8 cm from the nipple. Right breast appears red and warm.A targeted right ultrasound was performed for the patient’s area of concern at 10:00 position. Ultrasound demonstrates skin thickening and edema. At 10:00 position there are 2 adjacent oval to round hypoechoic to anechoic areas with few areas of through transmission, measuring 1.6 x 1.3 x 1.6 cm and 1.6 x 1.1 x 1.1 cm. Adjacent to these 2 hypoechoic areas is an area of increased echogenicity. Patient denies history of trauma and is not on any blood thinners.
2 adjacent hypoechoic areas with adjacent hyperechogenicity in the right breast 10:00 position corresponding to the palpable abnormality most likely represents area of hematoma/fat necrosis versus abscess. Also noted is right breast skin thickening and edema consistent with cellulitis.Surgical consultation to be performed if clinically indicated. Findings and recommendations were discussed with Dr. Ram Krishnamoorthi at pager 4111.After patient completes her course of antibiotics if things resolve, follow-up ultrasound can be performed.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.