This is a case of mildly dilated mammary duct in a 35-year-old female patient who presented with right breast discomfort. I will describe the ultrasound findings, the diagnosis, the prognosis and the management of this condition.
Ultrasound Findings
The patient underwent ultrasound imaging of her right breast, which revealed:
- A mildly dilated mammary duct of 1.4 mm diameter at 9 o clock position in the right breast
- No nipple discharge
- Color Doppler ultrasound showed no vascularity
- No breast masses seen
The ultrasound images are shown below:
Diagnosis:
Based on the ultrasound findings, the most likely diagnosis is solitary duct ectasia. This is a benign condition that occurs when one or more mammary ducts beneath the nipple widen and fill with fluid. The duct walls may thicken and become blocked or clogged with a sticky substance.
Mammary duct ectasia is more common in women during perimenopause (around age 45 to 55 years), but it can also occur after menopause. The exact cause of mammary duct ectasia is unknown, but some factors that may be associated with it are:
- Breast tissue changes due to aging
- Smoking
- Nipple inversion
- Previous breast surgery or trauma
More on solitary mammary duct ectasia:
Solitary duct ectasia is a rare type of asymmetric duct ectasia that is suspicious for malignancy and biopsy should be considered (BI-RADS 4) . It is the abnormal widening of one or more breast ducts to greater than 2 mm diameter, or 3 mm at the ampulla. It can be due to benign or malignant processes. On ultrasound, it appears as distended branching or tubular structures with anechoic contents measuring more than 2 mm diameter. Features that on ultrasound should raise suspicion for malignancy include nonsubareolar location, hypoechoic intraluminal contents, ductal wall irregularity or indistinctness, or solid parenchymal mass.
In our case:
A solitary duct ectasia of 1.4 mm breast on ultrasound imaging may not meet the criteria for duct ectasia, as it is less than 2 mm in diameter. However, it may still be a sign of intraductal malignancy, especially if it is associated with other suspicious features. In our patient, no other findings were observed.
Symptoms:
Mammary duct ectasia often does not cause any signs or symptoms, but some people may experience:
- A dirty white, greenish or black nipple discharge from one or both nipples
- Tenderness in the nipple or surrounding breast tissue (areola)
- Redness of the nipple and areolar tissue
- A breast lump or thickening near the clogged duct
- A nipple that's turned inward (inverted).
In some cases, mammary duct ectasia may also lead to a bacterial infection called periductal mastitis, which causes breast pain, inflammation and fever.
Prognosis:
Mammary duct ectasia is not a risk factor for breast cancer, and it usually does not affect the ability to breastfeed. However, it may cause discomfort and distress for some women, especially if there is nipple discharge or infection.
The prognosis of mammary duct ectasia depends on the severity of the symptoms and the response to treatment. In most cases, mammary duct ectasia resolves without any treatment or with self-care measures. In some cases, antibiotics or surgery may be needed to treat an infection or remove the affected milk duct.
Management:
The management of mammary duct ectasia depends on the symptoms and preferences of the patient. Some options are:
- Self-care measures: These include applying warm compresses to the nipple and surrounding area, using breast pads or nursing pads to absorb nipple discharge, wearing a support bra to minimize breast discomfort, sleeping on the opposite side of the affected breast, and stopping smoking.
- Antibiotics: These may be prescribed for 10 to 14 days to treat an infection caused by mammary duct ectasia. It is important to take all the medication as prescribed, even if the symptoms improve or disappear.
- Surgery: This may be considered if an abscess has developed and antibiotics and self-care do not work, or if the symptoms are persistent and bothersome. The surgery involves making a tiny incision at the edge of the areola and removing the affected milk duct. The surgery rarely affects the appearance of the breast or nipple.
#Conclusion:
Mammary duct ectasia is a benign condition that occurs when one or more milk ducts beneath the nipple widen and fill with fluid. It often does not cause any symptoms, but it may cause nipple discharge, breast tenderness, inflammation or infection. It is not a risk factor for breast cancer, and it usually does not affect breastfeeding. The management of mammary duct ectasia depends on the symptoms and preferences of the patient. It may include self-care measures, antibiotics or surgery.
Disclaimer: This blog post is for informational purposes only.
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References:
(1) Mammary duct ectasia - Diagnosis & treatment - Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/mammary-duct-ectasia/diagnosis-treatment/drc-20374806.
(2) Mammary duct ectasia - Symptoms & causes - Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/mammary-duct-ectasia/symptoms-causes/syc-20374801.
(3) Duct Ectasia of the Breast - American Cancer Society. https://www.cancer.org/cancer/types/breast-cancer/non-cancerous-breast-conditions/duct-ectasia.html.
(4) Mammary Duct Ectasia: How Does it Impact Your Health? - WebMD. https://www.webmd.com/skin-problems-and-treatments/what-is-mammary-duct-ectasia.
(5) Mammary Duct Ectasia: Symptoms, Causes, Diagnosis, and Treatment. https://www.verywellhealth.com/mammary-duct-ectasia-is-a-benign-breast-condition-430687.
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