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Table 3 Ultrasonic characteristics of common pathologies of the lactating breast

From: Ultrasound imaging of the lactating breast: methodology and application

Pathology Ultrasonic appearances
Cyst Margins – well circumscribed with thin smooth walls
Centrally anechoic
Posterior enhancement
Edge shadowing
No internal vascularity
Fibroadenoma Margins – well defined or occasionally ill-defined
Echogenicity – homogenous to heterogenous
No posterior enhancement unless internal calcification is present
Internal vascularity
Abscess Margins – wide, indistinct, hypoechoic
Echogenicity – predominantly echo-free to heterogenous
Posterior enhancement
No internal vascularity
Malignancy Margins – irregular and ill-defined
Echogenicity – heterogenous echogenicity
Stellate appearance
+/- posterior shadowing
Internal vascularity
Galactocele Acute – anechoic and simple or mainly anechoic with some diffuse echoes and multiloculated.
Sub-acute – contain echoes of mild to moderate intensity
Chronic – diffuse echogenicity ranging from moderate to highly echogenic
Can be simple, multilocular and heterogenous
Possible fat-fluid level
Movement of the contents can be demonstrated by compression with the transducer
Galactoceles are centrally devoid of blood vessels however flow may be demonstrated in the walls – use of colour Doppler can confirm this
Blocked duct Focal – similar appearances to an acute galactocele, non-compressible.
Diffuse – often an area of increased echogenicity associated with a palpable solid region. Occasionally a hypoechoic rim surrounds a more echogenic central region
Lactating adenoma Margins – well circumscribed to ill-defined
Echogenicity – hypo-, hyper or isoechoic
Homo- or heterogenous
Posterior enhancement or acoustic shadowing
+/- internal vascularity
Engorgement Increased echogenicity of the glandular tissue due to the large volume of milk in the breast.
Severe engorgement may exhibit ultrasonic signs similar to mastitis (see below)
Mastitis Early/acute phase: there may be no discernable ultrasonic changes in echogenicity breast tissues
Skin – thickens and becomes more hyperechoic
Cooper's ligaments and stromal fibrous tissue decrease in echogenicity
Areas of inflammation frequently have increased blood flow
Advanced stages: Skin thickening is prominent
Distinction between different breast tissues disappears
Breast thickness increases