Pediatric emergency medicine trisk 0415 0415

CHAPTER 16 ■ BREAST LESIONS
JONATHAN ORSBORN, RAKESH D. MISTRY

INTRODUCTION
Most breast lesions in children and adolescents are benign and self-limited, and
patients and their families will generally benefit from reassurance that neoplastic
diseases of the breast are extremely rare in all pediatric age groups. This chapter
focuses on the diagnostic approach to the variety of breast lesions, and discusses
the management of common etiologies that pediatric emergency physicians are
likely to encounter.

DIFFERENTIAL DIAGNOSIS
Breast lesions in children are typically divided into the following categories:
infections, benign cysts or masses, malignant masses, abnormal nipple secretions,
lesions associated with pregnancy and lactation, and miscellaneous causes,
including both anatomic and physiologic entities ( Table 16.1 ). A complete
history and physical examination narrow the differential diagnosis and usually
provides sufficient information to guide management. With few exceptions, most
breast lesions require little diagnostic testing in the emergency department (ED)
and typically can be managed with supportive care and occasionally, outpatient
referral to an appropriate specialist. The commonly encountered disorders ( Table
16.2 ) are almost always benign, but consideration must be given to potentially
life-threatening processes ( Table 16.3 ).

Breast Infections
Infection in the breast may take the form of a mastitis, cellulitis, or abscess. The
incidence of breast infection occurs bimodally, with the early peak in the neonatal
age group and the later, more common, peak in postpubertal females. Neonatal
breast infection (mastitis neonatorum) most frequently presents in the first few
weeks of life, commonly resulting from infection of the already enlarged breast
bud produced by intrauterine maternal estrogen stimulation. As a result, mastitis

neonatorum is more likely to occur in full-term, as opposed to premature infants.
The most common infecting organism is Staphylococcus aureus in >75% of
cases, although gram-negative enterics, anaerobes, group A or group B
streptococci may be isolated. More recent studies have demonstrated an increased
incidence of community-associated methicillin-resistant S. aureus (CA-MRSA).