BREAST DISCHARGE

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 are pituitary tumor, 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.

BREAST 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 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)

Book Source Details

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

Other Book Chapters Related to Breast symptoms

Read excerpts from these other book chapters related to Breast symptoms:

Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

More About Causes of Breast symptoms

• Back to symptom: Breast symptoms: Introduction (review 210 causes)
• Next Book Extract About Breast symptoms: BREAST PAIN (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Breast symptoms

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

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