Findings and diagnosis
Findings
An initial point-of-care ultrasound displayed an area of induration of the right breast as well as soft-tissue edema with no identifiable fluid collection. A subsequent CT of the abdomen and pelvis was obtained given new onset of abdominal pain, which demonstrated incidental findings of inflammatory changes and subcutaneous emphysema along with colonic diverticulosis.
Differential diagnosis
- Breast abscess
- Breast cyst
- Breast carcinoma
- Cellulitis
- Fibroadenoma
- Breast necrotizing fasciitis
- Mastitis
- Fat necrosis
Diagnosis: Breast necrotizing fasciitis
Treatment
Surgical intervention was immediately sought for which she underwent debridement and exploration of the right breast with findings that were consistent with necrotizing transformation. The patient was sent back to the operating room for additional surgical debridement. Of note, the patient had post-op atrial fibrillation (AFib) with a rapid ventricular response and had to be admitted to the intensive care unit for conversion to sinus rhythm. She returned to sinus rhythm and was transferred back to medicine before application of a negative pressure wound dressing on discharge. The patient was transitioned from enoxaparin to apixaban for anticoagulation control in the setting of AFib before being discharged to a skilled nursing facility with long-term antibiotics. This case highlights the difficulty and significance of establishing a prompt diagnosis for necrotizing fasciitis.
