Breast Mass in a Pregnant Woman

Fig.1 Ultrasound at 4 o'clock of the right breast shows a 2-cm solid-appearing mass (arrows) with posterior acoustic enhancement (arrowheads) in a young pregnant woman who had breast tenderness for several weeks. 
Fig. 2 Color Doppler ultrasound of the mass reveals increased blood flow to the periphery of the mass within central flow. 

Discussion: In this case, a real-time ultrasound would be useful to observe if there are 'floating particles' within the mass or not. If present, it would indicate that the mass is not solid, but filled with echogenic materials. With a single gray-scale image (Fig. 1), differential diagnoses are broad - and of course, a real solid mass is not excluded. In Fig. 2, though, a peripheral rim of vascular flow is present without central flow. This finding would be supportive of an abscess or a complicated cyst (hemorrhagic, infected cyst).  However, further action would be needed to confirm it.

Diagnosis: Breast abscess confirmed by ultrasound-guided aspiration.

Points:

• Ultrasound is the primary method for evaluation of young women with breast complaints
  
• In pregnant women with a solid-appearing breast mass, differential diagnoses are fibroadenoma, breast cancer and solid-appearing abscess (like in this case). 
  
• Ultrasound is used to guide interventional diagnostic and therapeutic procedures of the breast.

Reference:

Yang W, et al. Diagnostic breast ultrasound: current status and future directions. Radiol Clin N Am 2007.