Diagnosis of Mastitis

Diagnosis of Mastitis

Diagnosing mastitis involves a combination of clinical evaluation, patient history, and sometimes diagnostic imaging or lab tests. Mastitis is often diagnosed based on typical symptoms and physical signs, especially in breastfeeding women. However, other conditions, such as inflammatory breast cancer or abscesses, can mimic mastitis. A careful assessment is necessary to ensure accurate diagnosis and treatment.

1. Patient History and Symptom Discussion

The diagnostic process starts with gathering a detailed medical history. The healthcare provider will ask about:

• Breastfeeding status (e.g., when the baby was born, any latching problems)
• When the breast pain or swelling began and how long it has lasted
• Whether there is a fever or chills
• Any recent nipple trauma, cracks, or discharge
• Use of breast pumps or tight bras
• If the patient has had recurrent mastitis or a previous diagnosis

In breastfeeding women, mastitis often happens within the first six weeks postpartum, but it can appear at any time. For non-lactating individuals, more investigation may be needed to rule out other causes.

2. Physical Examination of the Breasts

A breast exam is key to diagnosing mastitis. The provider will:

• Look for redness, swelling, or skin changes on both breasts
• Feel for lumps that are firm or painful
• Check for cracks, discharge, or inflammation on the nipple and areola
• Check if the area feels warm, hard, or soft, which could indicate an abscess

In infectious mastitis, the affected area often shows a wedge-shaped area of redness, tenderness, and swelling. Non-infectious inflammation may look similar but usually doesn’t cause a fever or discharge that looks like pus.

3. Measuring Body Temperature

A high temperature can help confirm the diagnosis of infectious mastitis. Fevers above 38.5°C (101.3°F) are common in bacterial infections. If the fever persists, it may suggest the need for stronger treatment or the development of an abscess.

4. Milk Culture and Sensitivity (in Specific Cases)

Though not always needed, testing the milk can help in complex or recurring cases. A milk sample can be tested to:

• Identify the bacteria causing the infection (usually Staphylococcus aureus)
• Check for antibiotic resistance
• Rule out rare or resistant infections

This test is more common when:

• The condition is severe or requires hospital care
• Antibiotics don’t seem to work
• Mastitis keeps coming back, or MRSA is suspected

5. Complete Blood Count (CBC) and Inflammatory Markers

Blood tests can show signs of infection or inflammation, including:

• Higher white blood cell (WBC) count
• Increased C-reactive protein (CRP)
• Raised erythrocyte sedimentation rate (ESR)

While these results are not specific, they help support the suspicion of an infection and can guide the next steps in treatment.

6. Breast Ultrasound

Breast ultrasound is an important tool, especially if:

• A breast abscess is suspected
• A lump doesn’t go away with treatment
• Symptoms continue even after antibiotics
• The patient is over 40 or non-lactating, increasing concerns about cancer

An ultrasound can help tell the difference between simple mastitis, abscesses, cysts, and solid tumors. In the case of an abscess, ultrasound often shows a fluid-filled cavity with or without surrounding inflammation.

7. Fine Needle Aspiration (FNA) or Biopsy

In rare cases, such as when mastitis doesn’t improve after treatment, or in non-breastfeeding women, further testing may include:

• Fine needle aspiration (FNA): To collect pus or tissue for testing
• Core needle biopsy: If cancer is suspected

These tests help doctors distinguish between chronic mastitis, granulomatous mastitis, and inflammatory breast cancer, as all can look like infectious mastitis.

8. Differential Diagnosis: Conditions That Mimic Mastitis

It’s important to rule out other breast conditions that might look like mastitis. These include:

If there is any doubt, it’s best to refer the patient to a breast specialist or surgeon.

9. Special Considerations in Non-lactating Women

Mastitis in women who are not breastfeeding is rare and needs careful evaluation. In these cases:

• A full breast exam and imaging are essential
• A biopsy may be needed to rule out cancer
• Other potential causes, such as smoking, duct ectasia, or autoimmune disease, should be considered
• If symptoms persist or keep returning, more detailed testing is needed

10. When Referral Is Necessary

Referral to a breast specialist, surgeon, or infectious disease expert may be needed if:

• Symptoms don’t improve after 48–72 hours of antibiotics
• An abscess needs draining
• There is suspicion of breast cancer
• The diagnosis is unclear in non-lactating women
• There is recurrent or bilateral mastitis

Timely referral ensures the best care and avoids delays in identifying serious underlying issues.

Summary

To conclude, diagnosing mastitis generally starts with a clinical evaluation based on typical symptoms and physical findings, particularly in breastfeeding women. Additional tests, like breast ultrasound, milk cultures, or blood tests, are used for severe, persistent, or unusual cases. Accurate diagnosis helps rule out more serious conditions, like abscesses or breast cancer. Early detection leads to faster recovery, helps continue breastfeeding, and prevents complications.

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