What tests are needed for mastitis?

The main symptoms of mastitis include milk stasis, local fever, distension and pain, etc., which are mainly due to pathogenic bacteria invading the mammary ducts and causing purulent infection. However, if it is not treated well, it will cause abscesses. So how to check it?

1. Blood routine test

In the acute phase, white blood cell and neutrophil counts increase. When sepsis occurs, the white blood cell count is often 1.5×10^10/L, and the neutrophil count is often above 0.8.

2. Bacteriological examination

(1) Pus smear: Pus is extracted for smear examination. Generally, Gram-positive cocci can be seen. Acid-fast staining can also be performed to detect acid-fast bacilli to help determine the type of pathogen.

(2) Pus culture and drug sensitivity test: to guide the clinical selection of antibiotics.

(3) Blood bacterial culture: When acute mastitis is complicated by sepsis, blood should generally be drawn for bacterial culture every other time until the result is negative. The best time to draw blood is before chills or high fever is expected to occur, which can increase the positive rate. For patients whose clinical manifestations are very similar to bacteremia but whose blood cultures are negative for multiple times, the possibility of anaerobic infection should be considered and blood can be drawn for anaerobic culture.

3. Local puncture and drainage of pus

For deep breast abscesses with obvious inflammation but no fluctuation, puncture and aspiration can be performed to help determine the location of the deep breast abscess.

4. X-ray mammography

The breast skin is swollen and thickened, the interstitial shadows proliferate and twist, the vascular shadows increase significantly, and the inflammatory changes are significantly changed after the application of antibiotics.

5. Ultrasound examination

The preferred method for non-destructive inspection. The audio and video characteristics are as follows.

(1) Inflammatory mass with unclear boundaries, thickened and enhanced internal echoes, and uneven light spots.

(2) Milk retention, which is a small dark area without echo.

(3) Abscess formation: The ultrasound image shows an uneven fluid-clearing area inside the abscess with blurred edges, local thickening of the mass, and sometimes stratification. The sound behind the abscess is enhanced.