Breast Discharge

Breast Discharge: Excerpt from Differential Diagnosis in Primary Care

A purulent discharge from the breast, just like a purulent discharge from any other body orifice, should signify inflammation (mastitis or breast abscess), yet this is not the most common cause of a nonbloody discharge from the breast. Obviously, the most common cause is lactation. This is, of course, physiologic in the postpartum period, but what about other periods of a woman’s life? The cause in these cases is usually a pituitary, hypothalamic, or ovarian disturbance causing excessive production of prolactin. Among these disturbances are pituitary tumors, Chiari–Frommel syndrome, and ovarian atrophy or tumors. Hyperthyroidism may occasionally be responsible. Certain drugs such as chlorpromazine hydrochloride (Thorazine) and methyldopa (Aldomet) may also cause galactorrhea. Certainly malignancy, particularly papillomas or carcinomas of the ducts, should be considered, but they usually produce a bloody discharge.

Approach to the Diagnosis

The workup of purulent breast discharge is usually simply a smear and culture and occasionally a white blood cell (WBC) count and differential. When these are fruitless, an acid-fast smear and culture may be indicated; however, this rarely occurs. It concerns me that tuberculosis is almost invariably given too much space in other differential diagnosis textbooks. Mammography is ordered next. For an endocrine workup, skull x-ray films, a CT scan or MRI of the brain, and determination of serum prolactin levels may be done, but it is wise to refer the patient to an endocrinologist for further evaluation and diagnostic assessment.

Other Useful Tests

1. Cytology study of exudate (neoplasm)
2. Fine-needle aspiration (cysts)
3. Biopsy (neoplasm)
4. Lymph node biopsy (neoplasm)
5. Sonogram (distinguish cyst from neoplasm)

Pictures

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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