E2035. Breast Imaging After-Hours: Approach to the ER Patient
University of Florida
Patients often present to the emergency department for breast-related symptoms, including breast pain, lumps, and/or nipple discharge. The majority of the time, imaging is not appropriate in the emergency room and these patients should be counseled for the need to follow up for dedicated outpatient breast imaging (ie. mammography and/or targeted breast ultrasound). Our goal is to establish an easy to use algorithm for the careful selection of patients who require imaging work-up in the emergency room. We also will review the common imaging findings, pitfalls, and management recommendations for common breast emergency room cases.
Educational Goals / Teaching Points
1. Establish criteria for selecting patients who require breast imaging in the emergency room.
2. Review the ultrasound findings of breast abscess.
3. Discuss the evidence-based management recommendations for breast abscess.
4. Describe common pitfalls of the work-up of breast abscess/mastitis, using real cases from the emergency room.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
1. The clinical suspicion of breast abscess is the only true breast-related emergency. A thorough physical exam and history by the emergency physician (and sometimes supplemented by the radiologist) are imperative in selecting patients for imaging in the emergency room.
2. Targeted breast ultrasound is the first line imaging took for the evaluation of clinically-suspected abscess. We will discuss the imaging features and how to utilize the Breast Imaging-Reporting and Data System (BIRADS) lexicon descriptors to guide the differential diagnosis. We will also discuss the justification for the use of BIRADS category 4 assessment for breast abscess.
3. The evidence-based management of breast abscess in the emergency room setting supports image-guided aspiration or surgical drainage. We will discuss these techniques.
4. One important mimicker of mastitis/breast abscess is inflammatory breast carcinoma. We will use real cases from the emergency room to demonstrate the imaging similarities and how these similarities guide the BIRADS assessment and recommendations.
5. Compiling the history/physical exam and imaging findings, we will establish an easy-to-use algorithm for implementation by emergency, general, and breast radiologists.
The management of patients in the emergency room presenting with breast-related symptoms can seem daunting to both the clinician and radiologist. We will review the current evidence-based recommendations for imaging work-up and management options, with a goal audience of emergency, general, and breast radiologists.