Differential Diagnosis for Breast Pain

The patient presents with left breast pain, particularly on palpation, and mild right breast pain. Given the history and physical examination, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Fibrocystic Changes: This is the most common cause of breast pain, especially in young women. The pain is often cyclic, but can be constant, and is usually bilateral, although one breast may be more affected than the other. The fact that the pain is worse on palpation and the patient has a recent history of taking medications for flu (which could potentially influence hormonal balance) supports this diagnosis.

• Other Likely Diagnoses

  • Hormonal Fluctuations: Hormonal changes throughout the menstrual cycle can cause breast tenderness. Given the patient's age and the nature of the pain, this is a plausible explanation.
  • Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause breast pain, especially if the lower breast is affected, as in this case.
  • Musculoskeletal Pain: Poor posture, muscle strain, or sleeping position could contribute to breast pain, although the patient does not think her sleep position is related.

• Do Not Miss Diagnoses

  • Breast Cancer: Although less common in young women, breast cancer must be considered, especially if a lump is suspected. The patient's sister, a nurse, was unable to determine if a lump was present, making thorough evaluation crucial.
  • Inflammatory Breast Cancer: This rare but aggressive form of breast cancer can cause pain, swelling, and redness, although the patient does not exhibit the latter two symptoms.
  • Pregnancy-Related Changes: Although the patient is nulliparous and not sexually active, pregnancy should always be considered in women of childbearing age presenting with breast changes or pain.

• Rare Diagnoses

  • Thyroid Disease: Both hypothyroidism and hyperthyroidism can cause breast pain, although this would typically be accompanied by other systemic symptoms.
  • Sarcoidosis: This autoimmune disease can cause granulomatous inflammation in various parts of the body, including the breast, leading to pain and lumps.
  • Breast Abscess: Although typically associated with signs of infection such as redness, swelling, and fever, a deep or small abscess might not exhibit these classic signs.

Management should include a thorough physical examination, possibly by a healthcare provider with expertise in breast examination, imaging studies (such as ultrasound or mammography, depending on the patient's age and symptoms), and consideration of a pregnancy test. Hormonal and musculoskeletal causes can often be managed conservatively, while other diagnoses may require specific treatments or further investigation.