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Mastitis: Inflammation of the Breast

by Carlo Raj, MD
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    00:01 Acute mastitis, inflammation.

    00:04 What then happens here? Well, now at this point the newborn is suckling on the nipple.

    00:08 And while suckling, well, perhaps the newborn ends up biting on the nipple too hard.

    00:13 At this point, there’s an introduction of a laceration into the nipple, when such laceration takes place, the number one organism that you want to keep in mind or a very common organism that you want to keep in mind with entry into the nipple and thus causing acute mastitis will be Staph aureus.

    00:31 Usually, unilateral.

    00:33 You have a newborn that basically is suckling on one causing lesion, localized area of inflammation, acute mastitis.

    00:42 May then form abscesses as you can imagine because this is a bacterial infection.

    00:47 And to the point where what you want to pay attention to, is that whenever there’s inflammation and if you’re thinking abscesses, because inside the abscess, all the neutrophils releasing an enzyme causing liquefactive necrosis within the abscess, localized in that area of the abscess, perhaps it appears purulent or yellow-like.

    01:09 However, the surrounding tissue as you can imagine, whenever there’s an inflammatory process, you would expect there to be erythema.

    01:15 Diffuse spreading of the infection is a possibility.

    01:21 Other breast inflammatory syndromes.

    01:24 I want you to break up this name here.

    01:28 Mammary, duct, ectasia.

    01:31 Ectasia means enlargement.

    01:34 Good. Or dilation.

    01:36 What is being dilated? The duct.

    01:38 Why? Let’s take a look.

    01:40 It occurs most commonly in the fifth or sixth decade of life.

    01:44 Usually postmenopausal.

    01:46 Usually in multiparous women, presents with palpable periarealoar mass with skin retraction.

    01:54 So what exactly is occurring here? Well, there’s every possibility that there might be an inflammatory process.

    01:59 During the inflammatory process, there might be increased dilation or ectasia of the mammary duct and during the repair process, what does that mean to you? Fibrosis or scar formation.

    02:10 If there is fibrosis or scar formation, you can only imagine that now – Remember, a scar always is going to contract the respective muscle or the respective tissue.

    02:20 Here, the respective tissue might be the nipple.

    02:22 It literally is then going to cause skin retraction.

    02:25 Do not confuse this with breast cancer, is that clear? This is mammary duct ectasia.

    02:31 Thick, cheesy nipple secretion.

    02:34 You’re thinking about an inflammatory process.

    02:39 Here we have focal necrosis of fat, tissue, and breast.

    02:42 Here, remember in basic pathology, you have learned about necroses and the specific necrosis you’re paying attention would be fat necrosis.

    02:52 Under fat necrosis, you then divide it into enzymatic and traumatic fat necrosis.

    02:57 This obviously is going to be an example of traumatic fat necrosis.

    03:02 In a lady with breasts, she has increased amounts of adipose tissue.

    03:06 If she gets into an accident, in which then let’s say, she’s driving a car and she hits a tree.

    03:12 And at this point, there’s trauma that’s being introduced to the breast.

    03:16 What kind of necrosis are the breasts undergoing? Good.

    03:19 Trauma or traumatic fat necrosis.

    03:23 When there’s such necrosis taking place, obviously, there might be hemorrhage into the early stages of the lesion, followed by – Well, oftentimes, you can have one type of necrosis that very much is then connected or associated with another.

    03:38 So please be careful and use common sense.

    03:42 Let me walk you through another one real quick.

    03:44 Remember the pancreas? And if it got destroyed, if it got damaged or or if there’s hypertryglyceride, that was an example of enzymatic fat necrosis.

    03:53 Now, technically correct, it’s enzymatic fat necrosis.

    03:56 But when you’re releasing such enzymes in great quantity, aren’t you then destroying all tissues surrounding it? Yes.

    04:03 Would you call that liquefactive necrosis? Of course, you would.

    04:07 Same concept here.

    04:09 But this time we have fat necrosis.

    04:10 Traumatic type.

    04:12 Eventually, with the enzyme being released, you might have liquefaction that might be taking place in the area.

    04:17 Try not to be too black and white.

    04:19 Understand that this is medicine and there’s a lot of things that are gray in a continuum.

    04:23 This will be good example of that.

    04:26 Next, you want to be able to identify and understand the description of the traumatic fat necrosis.

    04:33 At this point, all of the ill-defined nodule of gray-white firm tissue containing small foci, what then accumulates with any type of necrosis if there’s enough damage? Oh, there might be calcium So whenever calcium accumulates, then you can expect that to be chalky white white or perhaps hemorrhagic debris.

    04:53 All components of necrosis, use common sense, understand that whenever there’s damage to tissue, there’s surrounding blood vessels which may then leak into it or perhaps enzymes that come into play and causing liquefactive type of necrosis.

    05:07 A couple of important integrated points here in basic pathology.

    05:11 It’s nice to see application of things that you’ve learned in the past and you will continue to do so.


    About the Lecture

    The lecture Mastitis: Inflammation of the Breast by Carlo Raj, MD is from the course Breast Disease.


    Included Quiz Questions

    1. Results in coagulative necrosis.
    2. Usually caused by S. aureus infection
    3. Usually caused by nursing infant
    4. Usually unilateral
    5. May form an abscess.
    1. Trauma to the chest
    2. DNA repair failure
    3. Duct dilation
    4. Estrogen excess
    5. Staphylococcus infection
    1. More likely in multiparous women.
    2. More likely in women of reproductive age.
    3. None are correct.
    4. All are correct.
    5. Usually occurs in 3rd or 4th decade of life.
    1. Mammary duct ecstasia
    2. Focal necrosis of fat tissue of the breast
    3. Macromastia
    4. Chronic mastitis
    5. Acute mastitis

    Author of lecture Mastitis: Inflammation of the Breast

     Carlo Raj, MD

    Carlo Raj, MD


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