BREAST DISCHARGE

Ask the following questions:

1. Is the discharge unilateral or bilateral? If it is unilateral and watery or bloody, one should look for a neoplasm in the breast. If it is bilateral and milky, one should look for the various conditions that cause hyperprolactinemia or pregnancy.
2. Is the discharge bloody? A unilateral bloody discharge is most suggestive of carcinoma of the breast. Other types of lesions of the breast, such as Paget's disease, papillary cystadenoma, and epithelioma of the nipple, are causes of a bloody discharge also.
3. Is there a focal mass in the breast? A bloody discharge with a focal mass makes a neoplasm almost certain. If there is a focal mass, fever, and a nonbloody discharge, one should consider abscess.
4. Is there fever? Fever or chills along with a purulent discharge from the breast is most likely acute mastitis or an abscess.

DIAGNOSTIC WORKUP

If there is a bloody discharge, one should not hesitate to refer the patient to a general surgeon, who will probably order mammography and perform a biopsy. The type of biopsy may be either a fine-needle aspiration or fine-needle biopsy or excisional biopsy, but the general surgeon can decide which is appropriate for any given patient. A unilateral nonbloody discharge may be studied further by ordering tests for occult blood, cytology, and mammography before referral. Remember that exploratory surgery may be the only way to get a diagnosis.

If the discharge is bilateral and milky, a serum prolactin should be ordered. If the prolactin is high, referral to an endocrinologist is probably the best step to take next. The endocrinologist will probably order a CT scan of the brain and pituitary and do further workup studies based on his examination.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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