Differential Diagnosis for Bilateral Breast Pain and Associated Symptoms
- Single most likely diagnosis:
- Fibrocystic breast changes: This condition is very common and can cause bilateral breast pain, burning sensations, and lumps due to hormonal fluctuations. The symptoms often worsen premenstrually and can be exacerbated by caffeine and other factors.
- Other Likely diagnoses:
- Breast cysts: These are fluid-filled sacs within the breast that can cause pain, especially if they become large or numerous. They can also cause a sensation of lumps.
- Mastitis: Although more commonly associated with breastfeeding, mastitis can occur in non-lactating women and cause pain, swelling, and sometimes a lump.
- Costochondritis (Tietze's syndrome): Inflammation of the cartilage that connects the ribs to the breastbone can cause chest pain that may be mistaken for breast pain.
- Hormonal fluctuations: Changes in hormone levels, such as those experienced during the menstrual cycle or with the use of hormonal contraceptives, can lead to breast tenderness and pain.
- Do Not Miss diagnoses:
- Breast cancer: Although less likely to present with bilateral symptoms, breast cancer must always be considered, especially if there's a palpable lump or significant asymmetry. It's crucial to perform a thorough examination and consider imaging studies if warranted.
- Cardiac issues (e.g., myocardial infarction, angina): Chest pain can sometimes be referred to the breasts, and cardiac conditions can be life-threatening if not promptly diagnosed and treated.
- Pulmonary embolism: While less common, a pulmonary embolism can cause chest pain that might be confused with breast pain, especially if it radiates or is associated with shortness of breath.
- Rare diagnoses:
- Sarcoidosis: A systemic disease that can cause granulomatous inflammation in various parts of the body, including the breasts, leading to pain and lumps.
- Granulomatous mastitis: A rare inflammatory condition of the breast that can cause pain, swelling, and lumps, often mimicking other conditions like breast cancer.
- Neurogenic pain: Certain neurological conditions can cause referred pain to the breast area, which might be perceived as breast pain.