Breast Pain

Age: ‍ years old

Gender: female



HISTORY:

Presents with a ‍-‍day history of ‍rightleftbilateral mastalgia

Onset was ‍gradualsudden, started ‍whileafter ‍

Location is ‍diffuselocalized to ‍

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍

Described as ‍dullaching

Pattern ‍constantintermittentcyclical with menses

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective

Last menstrual period: ‍ ‍daysweeksmonths ago

Menstrual cycles: ‍ days, ‍regularirregular

Breastfeeding: ‍ongoingended since



Associated symptoms: *Try using right-click for negatives*

‍mass

‍nipple discharge

‍nipple retraction

‍breast skin changes

‍swelling

‍fatigue

‍fever, up to ‍°, over ‍ ‍hoursdays

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional



Contributing factors:

‍pregnancy

‍breastfeeding

‍menopause

‍high caffeine intake

‍high fat intake

‍high stress levels

‍smoking

‍obesity

no history of: ‍premenstrual syndrome, ‍fibrocystic breast changes, ‍previous breast surgeries or injury, ‍breast cancer, ‍infections/mastitis

no use of: ‍hormonal contraceptives, ‍hormone replacement therapy, ‍antipsychotics, ‍new medication

no family history of: ‍breast disorders





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Breasts: ‍normal, ‍mass, ‍axillary adenopathy

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness





ASSESSMENT:

‍Cyclic mastalgia ‍likelysuspectedpossible

DDx: cyclic mastalgia, non-cyclic mastalgia, fibrocystic breast changes, pregnancy-related breast changes, mastitis, breast abscess, duct ectasia, breast cysts, medication side effect, hormonal contraceptives side effect, hormone replacement therapy side effect, psychotropics side effect, breast trauma, breast surgery, fat necrosis of the breast, breast cancer, costochondritis, chest wall pain, thoracic outlet syndrome, herpes zoster, psychogenic pain





PLAN:

Investigations:

- Mammogram

- Ultrasound of the breast

- Blood work: ‍Prolactin, ‍TSH, ‍FSH, ‍LH, ‍Estradiol, ‍Progesterone, ‍ß-hCG

Treatments:

- ‍Analgesics

- ‍Hormonal therapy

- Change oral contraceptive for a lower estrogen dose

- Take oral contraceptives continuously

- Supportive bra

- Heat or cold compresses

- Dietary modifications: ‍avoid caffeine, ‍avoid salty foods, ‍avoid fatty foods

- Smoking cessation counseling

Further care:

- Referral to breast surgeon

- Referral to gynecologist

- Follow-up in ‍ ‍weeksmonths

- Return if pain worsens, if new symptoms develop such as nipple discharge, skin changes, or lump in the breast, or if symptoms do not improve with treatment.