This is a case of a middle-aged female patient who presented with a history of left nipple discharge of one week. The discharge was clear, non-bloody, and occurred spontaneously. She had no history of breast trauma, surgery, or lactation. She had no family history of breast cancer or other breast diseases. She was not taking any medications or hormonal supplements.
On physical examination, the left nipple and areola were normal in appearance, with no signs of inflammation, retraction, or ulceration. There was no palpable mass or axillary lymphadenopathy. A small amount of clear fluid could be expressed from the left nipple on gentle pressure.
Ultrasound imaging:
We performed an ultrasound scan of the left breast, which showed a non-vascular linear anechoic structure at the 12 o'clock position, measuring 2.5 mm in diameter and 3 cm in length. It extended from the subareolar region to the upper outer quadrant of the breast. There was no evidence of any solid mass, cyst, or calcification in the breast parenchyma. The right breast was normal on ultrasound.
Ultrasound imaging findings:
The ultrasound findings were suggestive of a dilated mammary duct, also known as duct ectasia. This is a benign condition that occurs due to the widening and thickening of one or more breast ducts, usually near the nipple. It is more common in perimenopausal and postmenopausal women, and may be associated with smoking. The dilated ducts may contain proteinaceous fluid, debris, or blood, which can leak out through the nipple and cause discharge.
Further tests:
To confirm the diagnosis and rule out any associated malignancy, I ordered a magnetic resonance imaging (MRI) scan of the left breast. The MRI showed a dilated tubular structure with high signal intensity on T1- and T2-weighted images, converging towards the nipple without any overlying mass. There was no enhancement after contrast administration. The MRI findings were consistent with duct ectasia and did not show any features suspicious for malignancy.
The differential diagnosis: of dilated ducts on breast imaging includes physiological lactational changes, mammary duct infection (mastitis), intraductal papilloma, intraductal carcinoma, and Paget's disease of the nipple. The clinical history, physical examination, and imaging features can help to narrow down the possible causes and guide further management.
Prognosis:
The prognosis of duct ectasia is generally good, as it is a benign condition that does not increase the risk of breast cancer. However, it may cause some discomfort and distress to the patient due to the nipple discharge and possible infection. Most cases of duct ectasia resolve spontaneously without any treatment.
Management:
Some self-care measures that can help to relieve the symptoms include applying warm compresses to the nipple, wearing breast pads to absorb the discharge, wearing a supportive bra, sleeping on the opposite side of the affected breast, and quitting smoking.
If there is evidence of infection, antibiotics may be prescribed for 10 to 14 days. If the symptoms persist or worsen despite conservative management, surgical removal of the affected duct may be considered as a last resort⁹. This procedure is done through a small incision at the edge of the areola and has minimal complications.
In conclusion, this case illustrates a typical presentation of duct ectasia in a middle-aged female patient with nipple discharge. Ultrasound and MRI are useful imaging modalities to diagnose this condition and exclude malignancy. Duct ectasia is a benign condition that usually resolves without treatment. However, some patients may require antibiotics or surgery if conservative measures fail.
For more, this kindle ebook on breast sonography:
For those in India:
References:
(1) [Mammary duct ectasia | Radiology Reference Article | Radiopaedia.org]
(2) Mammary duct ectasia | Radiology Reference Article | Radiopaedia.org. https://radiopaedia.org/articles/mammary-duct-ectasia.
(3) Dilated ducts on breast imaging (differential) - Radiopaedia.org. https://radiopaedia.org/articles/dilated-ducts-on-breast-imaging-differential?lang=us.
(4) Mammary duct ectasia - Diagnosis & treatment - Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/mammary-duct-ectasia/diagnosis-treatment/drc-20374806.
No comments:
Post a Comment