Breast pain/swelling DDx

Breast pain/swelling – Differential Diagnosis

Common causes

• Hormonal
  • Cyclical breast pain
  • Pregnancy
  • Contraceptives
• Fibrocystic disease
• Mastitis
• Abscess
• Chest wall pain
• Trauma
• GORD

Must Not Miss

• Breast cancer
• Rib Metastases
• Vascular
  • Pulmonary embolism
  • Myocardial Infarction

Easily missed

• Medication
• Herpes Zoster
• Spinal problems
• Psychogenic

Red flags

• New discrete breast lump
• Skin ulceration/distortion
• Recent nipple retraction or distortion
• Nipple eczema
• Nipple discharge particularly if blood stained
• Persistent asymmetrical nodularity
• Recurrent cyst/abscess
• Persistent or severe pain
• Enlarged axillary lymph nodes
• History of previous breast cancer
• Strong family history of breast cancer
• Cardiac pain/dyspnoea

Investigations to consider

• FBC, CRP/ ESR
• U&Es, LFTs, Bone profile
• Pregnancy test
• CXR
• USS
• Mammography
• FNAC/biopsy
• CT scan
• Bone scan