Differential Diagnosis for Periareolar Mass
- Single most likely diagnosis
- Fat necrosis: This is the most likely diagnosis given the patient's history of bilateral breast reduction 8 months ago. Fat necrosis can present as a firm, irregular mass and is often associated with trauma or surgery to the breast. The presence of echogenic internal bands without vascularity on ultrasound is also consistent with fat necrosis.
- Other Likely diagnoses
- Seroma: A seroma is a collection of fluid that can occur after surgery, and it can present as a palpable mass. The fact that the mass is nontender and has echogenic internal bands without vascularity makes seroma a possible diagnosis.
- Oil cyst: An oil cyst is a type of benign lesion that can occur after trauma or surgery to the breast. It can present as a firm, irregular mass and may have echogenic internal bands on ultrasound.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ductal carcinoma: Although the patient's history and ultrasound findings are not typical for ductal carcinoma, it is essential to consider this diagnosis due to its potential severity. Nipple retraction and a fixed mass can be signs of underlying malignancy.
- Breast abscess: Although the mass is described as nontender, a breast abscess is a possible diagnosis, especially if the patient has a history of recent surgery or trauma. It is crucial to rule out an abscess due to the potential for serious complications if left untreated.
- Rare diagnoses
- Fibroadenoma: Fibroadenoma is a type of benign breast tumor that can present as a firm, mobile mass. However, it is less likely in this case due to the patient's history of recent surgery and the presence of echogenic internal bands without vascularity on ultrasound.
- Hematoma: A hematoma is a collection of blood that can occur after surgery or trauma. Although it is a possible diagnosis, it is less likely given the time frame since the patient's surgery and the ultrasound findings.