Diagnosis and features of the treatment algorithm of non-lactational chronic mastitis on the example of a clinical case

Inflammatory processes in the mammary gland (MG) do not lose their relevance, the frequency of occurrence reaches 16% among all diseases of the MG. Non-lactational mastitis (NM) – inflammation in the MG outside the period of pregnancy and lactation – stands out among them [1]. With untimely and non-radical treatment of acute forms, there is a transition to chronic, with the formation of bacterial biofilm in the focus of inflammation and thick scar capsule after repeated surgical interventions, which is due to a vicious circle. The clinical picture of non-lactational chronic mastitis in most cases resembles a diffuse (mastitis-like, edematous-infiltrative) form of breast cancer (BC), which determines the differential-diagnostic difficulties in referring to a doctor both at initial treatment and at recurrence. This problem is faced by doctors of different specialties: oncologists, surgeons, gynecologists, therapists, specialists in radiation and radiological diagnostics [2, 3]. Radiation diagnostics is always the «gold standard» in the diagnosis of breast diseases, but has a number of disadvantages in the inflammatory process in the breast, and, in some cases, it is worth prioritizing the ultrasound method of investigation [4]. Through the combined interpretation of clinical data and ultrasound (USG) findings, the following parameters should be evaluated: skin thickness, pre-mammary fatty tissue, structure of glandular parenchyma of the MJ, presence and boundaries of inflammatory infiltrate/infiltrates in the MJ tissue; formation of «rarefaction» zones, microabscesses and/or already formed «draining» abscess cavities, assess the content of fluid cavities (homogeneity/homogeneity), the presence of pyogenic capsule, as well as the boundaries of inflammation/abscessing with unchanged breast tissue, taking into account possible «microfoci» outside the main mass of changes (like «satellites», «fluid spurs»). It is important to analyze the state of the ductal system of the breast (ductal diameter dilation, intraluminal content) and possible connection of ducts with abscessed areas, which may be a predictor of further spread of the process, recurrence or chronicization of the disease. Inflammation on the background of subacute and chronic process can lead to the development of fistulas [5]. However, there is not always the classic ultrasound picture of a purulent focus in the breast [6–9].