Latest
Recommended
Published: Tue, January 17, 2017
World | By Lorena Waters

Duct Ectasia - Explain Medicine

Duct Ectasia - Explain Medicine

Green, black, dirty white nipple discharge

Dilatation

Of large lactiferous ducts that fill up with a stagnant brown or green secretion. [1] Usually occurs spontaneously and is usually intermittent. [2]

Tenderness of nipple and surrounding breast

Peri-ductal mastitis or abscess formation due to bacterial infection of the stagnant fluid. [1]

Reddeness of the nipple and surrounding breast

Discharge of the stagnant fluid onto the surrounding skin creates an irritant reaction. [1] Nipple inversion

Fibrosis develops in a setting of chronic inflammation [1] causes shortening of the duct and the nipple [2] causing slit like nipple retraction.

Breast lump

Over time the continuity of the duct epithelium is broken leading to leaking of lipoid material [2] that forms a chronic indurated mass that appears beneath the areola. [1]

Mammillary duct fistula

With recurrent abscesses fistula formation of the ducts may occur [2]

Enlarged axillary lymph nodes [3] >

Reactive lymphadenopathy due to inflammation and abscess formation in the breast. RUSSELL RCG, WILLIAMS Norman S, BULSTRODE, Christopher JK Bailey and Love's Short Practice of Surgery.

23rd edition (International students) London. Arnold 2000.

ABRAMSON DJ. Mammary duct ectasia, mammillary fistula and sub areolar sinuses. Annals of Surgery. Lippincott Williams and Wilkins. February 1969, Vol. 169 (2) 217-226 [viewed 8 March 2014]. Available from DOI: 10.1097 / 00000658-196902000-00007 PETERSEN L, GRAVERSEN HP, ANDERSEN JA, DYREBORG U, BLICHERT-TOFT M. The duct ectasia syndrome. A prospective clinical study of patients with breast diseases. Ugeskr Laeger. May 1993, vol- 155 (20) 1545-9 [viewed 8 March 2014]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8316986

Fact

Explanation

Nipple discharge

Nipple retraction

Manifest as transverse slit like retraction [2] due to shortening of duct and nipple in a setting of chronic inflammation. > Chronic low grade infection of the peri-areolar area. Can progress to abscess formation when peri ductal mastitis is known. [2]

Mammillary fistula

Rupture of a peri ductal abscess on the skin will cause a fistula. [2]

Sub areolar lump

Indurated mass forms due to leakage of lipoid material from a lactiferous duct. [3] RUSSELL RCG, WILLIAMS Norman S, BULSTRODE Christopher J K. Bailey and Love's Short Practice of Surgery. 23rd edition (International students) London. Hodder Arnold 2000.

BROWSE Norman L, BLACK John, BURNAND Kevin G, THOMAS William E. G. Browse the Introduction to the Symptoms and Signs of Surgical Disease. 4th edition. Hodder Arnold 2005. ABRAMSON DJ. Mammary duct ectasia, mammillary fistula and sub areolar sinuses. Annals of Surgery. Lippincott Williams and Wilkins. February 1969, Vol. 169 (2) 217-226 [viewed 8 March 2014]. Available from DOI: 10.1097 / 00000658-196902000-00007

Fact

Explanation

Breast carcinoma

Nipple retraction in Breast CA differs in that it is circumferential as opposed to the transverse slit retraction seen in duct ectasia. [1] Other differentiating factors are blood stained nipple discharge, presence of hard irregular breast lump and hard immobile axillary nodes. [2]

Breast abscess

Commonly seen in the lactating breast due to Staphylococcal infections. [1] Will have features of acute inflammation and cellulitis of the overlying skin. [1] Breast lump will be tender and cystic.

DVIDS - News - Army Reserve soldiers train in cyber defense operations
In his civilian job, Brown deals with the security aspect of cyber defense and watches for intrusions to his company's network. When you have geographically dispersed units they tend to train in a vacuum.

Hall of Fame | DelValleKidd
Whether he's in pain or not, expect him to be front and center of his band on a few dozen dates supporting Bob Dylan this summer. But I've played some really horrible shows and cut them short because there was very little I could keep going. " 4.

Bright Starts InGenuity Cradle and Sway Swing Review - Thrifty Nifty Mommy
We now have 4 children: Maggie (age 7), Jacob (age 4), Zellene (age 2) and our youngest little guy Gideon born in February 2016. I have a habit of forgetting to pick up batteries when I'm out at the store, and it would be nice to have that power option.

Tuberculosis of the breast

Extremely rare presentation in developed countries. Has multiple chronic abscesses and sinuses. [1]

Bacterial mastitis

Hyperprolactinemia

Usually such physiological discharges are multi ductal in origin. [3] Nature of the discharge is milky white and non purulent. Possibility of a pituitary adenoma must be entertained. RUSSELL RCG, WILLIAMS Norman S, BULSTRODE, Christopher JK Bailey and Love's Short Practice of Surgery.

23rd edition (International students) London. Arnold 2000.

BROWSE Norman L, BLACK John, BURNAND Kevin G, THOMAS William E. G. Browse the Introduction to the Symptoms and Signs of Surgical Disease. 4th edition. Hodder Arnold 2005. BLAND Kirby I, COPELAND III Edward M. The Breast: Comprehensive Management of Benign and Malignant Diseases. 4th edition. Elsevier 2010

Fact

Explanation

Culture and antibiogram of the nipple discharge

To identify causative pathogens And prescription of appropriate antibiotics. [1] In duct ectasia 60% will have anaerobic growth. [2] Occult blood of nipple discharge Positive in 64%, this does not include or exclude the possibility of cancer but indicated intra ductal pathology. Warrants further investigation to exclude malignancy. [3]

Ductography

To identify the nature, extent and location of intra ductal lesions. [1]

Mammogram

Essential in the triple assessment of a breast lump. Should be performed if the patient is above 35 years. [1] This should precede the cytological investigation of a breast lump.

Fine Needle Aspiration Cytology (FNAC)

Needed in the triple assessment of a breast lump. An indurated mass in duct ectasia reveals foamy macrophages and inflammatory cells. [1]

Ultrasound scan

Fact

Explanation

Antibiotic therapy

The commonest infective organism is Staphylococcus aureus. Therefore treatment with flucloxacillin and addition of metronidazole to cover anaerobic organisms can be prescribed. [1] RUSSELL RCG, WILLIAMS Norman S, BULSTRODE Christopher J K. Bailey and Love's Short Practice of Surgery. 23rd edition (International students) London. Hodder Arnold 2000.

Fact

Explanation

Hadfields Procedure [ Areolar duct excision. This completely removes the dilated ducts thereby alleviating symptoms. [2]

Microdochectomy

Appropriate for single duct discharge without any mass and negative mammogram. [3] RUSSELL RCG, WILLIAMS Norman S, BULSTRODE Christopher J K. Bailey and Love's Short Practice of Surgery. 23rd edition (International students) London. Hodder Arnold 2000.

RICHARDS T, HUNT A, UMEH H. Nipple Discharge? A sign of breast cancer. The Annals of Surgery. Royal College of Surgeons England. March 2007 vol 89 (2) 124-126. [Viewed March 8 2014]. Available from: doi: 10.1308 / 003588407X155491 BURTON S, LI WY, HIMPSON R, SULIEMAN S, BALL A. Microdochectomy in women aged over 50 years. The Annals of Surgery. Royal College of Surgeons England. January 2003. vol - 85 (1) 47-49 [viewed 8 March 2014]. Available from: PMC1964348

Like this: