History and images

History: A 68-year-old African American woman with a past medical history of hypertension, hyperlipidemia, and poorly controlled diabetes mellitus presented with the complaint of a painful right breast abscess with intermittent, purulent drainage for the past week. The pain was constant at the site of the wound. The wound appeared open and superior to the inframammary fold with thick, foul-smelling drainage. She endorsed activity change, appetite change, nausea, and fatigue. She denied fever and was afebrile. The patient recalled a recent insect bite to the area. Click to enlarge the images.

Figure 1: Imaging obtained from a bedside ultrasound machine in the emergency department. The yellow box displays an area of induration at the inferior portion of the right breast and soft-tissue edema with no discrete drainable fluid collection.

Figure 2: CT imaging displays the reported inflammatory changes and subcutaneous emphysema of the right breast. Figure 2(A) displays an axial view with the yellow box demonstrating significant inflammatory changes and subcutaneous emphysema in the right breast. Figure 2(B) displays a sagittal view with the yellow box highlighting subcutaneous emphysema in the right breast and inflammatory changes. Figure 2(C) highlights the coronal view of the CT abdomen pelvis with the yellow box signifying the area of subcutaneous emphysema in the right breast and the abdominal wall.