Pilonidal abscess of the breast

Abstract

Pilonidal disease is a common condition, typically occurring in the natal cleft of adult males. Other sites of pilonidal sinus are rarely reported. We report a case of periareolar pilonidal abscess in the breast of a 52-year-old woman who presented via the breast clinic complaining of nipple inversion and pain. Clinical examination and imaging revealed an underlying abscess which recurred despite antibiotic therapy and needle aspiration; the patient therefore underwent surgical excision of the abscess cavity. Subsequent histology diagnosed pilonidal abscess, an important differential to consider in the case of breast abscess, particularly in cases that are slow to resolve or recur post-treatment.

Keywords: breast surgery; radiology.

Figure 1

Bilateral lateral oblique mammograms. Note poorly defined right retroareolar opacity (arrow) with overlying skin/areolar thickening and nipple inversion.

Figure 2

Axial fat-saturated postgadolinium MRI demonstrates right retroareolar ring-enhancing cystic lesion (arrow) with overlying nipple inversion.

Figure 3

H&E stain, low power image reveals inflammatory changes around a sinus tract.

Figure 4

H&E stain, high power image shows hair shaft centrally within the sinus tract (arrow).