Purpose or Case Report: Children and young adults can present with breast complaints in the emergency setting and ultrasound is typically the initial imaging modality of choice for work-up. While many sonographic findings are benign, there are rare presentations of indeterminate and suspicious masses. In these cases, radiologists and clinicians involved in these patient's care may be unfamiliar with the diagnosis and management of lesions that warrant follow-up with dedicated breast imagers. This study is designed to analyze the common characteristics of pediatric breast complaints from the emergency department and if follow-up care was recommended and pursued.
Methods & Materials: This retrospective study reviewed breast US examinations performed on patients 18 years of age and younger from the emergency department at a tertiary pediatric hospital from 1/1/15 to 12/31/19. Imaging findings, follow-up recommendations, and outcomes were obtained from the electronic medical record.
Results: A total of 75 breast US were performed in the emergency setting, with mean patient age of 13 (range 0-18). The most common presenting breast complaint was palpable lump (48% [36/75]), followed by both palpable lump and pain (27% [20/75]), breast pain (17% [13/75]), nipple discharge (5% [4/75]) and breast swelling (3% [2/75]). A benign correlate (ie glandular tissue, etc) occurred in 24% [18/75] of cases. An infectious etiology (ie abscess, etc) occurred in 45% [34/75] of cases. Benign-appearing mass occurred in 12% [9/75] of cases. A mass without benign sonographic features occurred in 7% [5/75] of cases. Of these suspicious masses, 40% (2/5) underwent biopsy with 1 revealing malignant spindle cell tumor in a patient presenting with a palpable lump. Of all sonographic masses, 71% (10/14) were given US follow-up recommendation for further evaluation with the breast clinic, of which 50% (5/10) of patients were lost to follow-up.
Conclusions: Careful evaluation sonographic findings of pediatric patients presenting with breast complaints in the emergency setting is recommended. While pediatic breast masses are rare, especially malignancies, identification of imaging features of suspicious breast lesions and effective communication of follow-up recommendations with dedicated breast imagers are essential. Emphasizing follow-up with the breast clinic at discharge for pediatric patients presenting with any mass in the emergency setting may be required to reduce the number of patients lost to follow-up and prevent missed breast cancer diagnoses.