Differentials
Chest wall pain
SIGNS / SYMPTOMS
Pain of chest wall origin is constant and non-cyclical.
May be related to physical activity.
On examination, the pain is elicited upon palpation of the chest wall by carefully displacing the breast tissue.
INVESTIGATIONS
Clinical differentiation usually suffices.
Costochondritis
SIGNS / SYMPTOMS
Pain over the anteromedial aspect of the chest wall, over the costochondral cartilaginous junction.
INVESTIGATIONS
Clinical differentiation usually suffices.
Fibroadenoma
SIGNS / SYMPTOMS
More often occurs in younger women who have a well-circumscribed palpable breast mass.
INVESTIGATIONS
Ultrasound may show internal echoes.
Biopsy of breast mass reveals fibroadenoma.[Figure caption and citation for the preceding image starts]: Ultrasound image of a fibroadenoma; in contrast to the breast cyst, some internal echoes are seenCourtesy of Limin Yang, MD, and Justin Boatsman, MD, Department of Radiology, University of Iowa Hospital and Clinics; used with permission [Citation ends].
Breast cancer
SIGNS / SYMPTOMS
May present with a palpable mass, often firm to palpation.
Presence of skin retraction or fixation to the chest wall should raise the suspicion of breast cancer.
INVESTIGATIONS
Biopsy of breast mass reveals breast cancer and type.
Intracystic papilloma
SIGNS / SYMPTOMS
May be able to feel a small lump under the nipple on examination.
INVESTIGATIONS
Breast biopsy is required for a definitive diagnosis and to rule out cancer.
Ultrasound, ductogram, and cytological examination of discharge for malignant cells are also useful.
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