ARRS 2022 Abstracts

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E1744. Squamous Metaplasia of the Lactiferous Ducts (SMOLD): An Under-Diagnosed Cause of Chronic Breast Disease
Authors
  1. Susan Tran; Gold Coast Hospital and Health Service
  2. Natasha Patrick; University of Tasmania
  3. Debra Meerkotter; I-Med Radiology Network
Background
Squamous metaplasia of the lactiferous ducts (SMOLD), previously known as Zuska’s disease, is a chronic disease related to smoking and is an under-recognized entity. It presents as recurrent subareolar abscesses and may be complicated with fistula formation. Certain areas in the world have high incidences of smoking. Increased awareness and therefore earlier diagnosis of SMOLD would allow for appropriate early intervention and thereby reduce the morbidity associated with recurrent painful and sometimes disfiguring disease.

Educational Goals / Teaching Points
The aim of this exhibit is to illustrate the radiographic appearances of squamous metaplasia of the lactiferous ducts and to emphasize the relationship of smoking with this chronic disease.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
SMOLD may present as a retroareolar asymmetric density on mammography. On ultrasound, SMOLD may present in a retroareolar location and may appear as a hypoechoic lesion with or without dilated ducts. Sinuses and/or fistulas may also be present.

Conclusion
SMOLD should be considered in young female smokers who presents with retroareolar abscess and sinus and/or fistula formation, particularly if recurrent. Management of SMOLD includes but is not limited to antibiotic therapy and smoking cessation. Only when SMOLD is widely recognized can the patient be given the correct diagnosis and consequently the appropriate management to improve their health outcome.