Differential Diagnosis for Nipple Discharge
- Single most likely diagnosis:
- Intraductal papilloma: This is often considered the most common cause of nipple discharge, particularly when the discharge is unilateral and bloody. Intraductal papillomas are small, benign tumors that grow in the milk ducts of the breast.
- Other Likely diagnoses:
- Duct ectasia: This condition involves the widening of a milk duct in the breast, which can cause nipple discharge. It's more common in older women and can lead to a thick, sticky discharge.
- Fibrocystic disease: While not typically associated with nipple discharge as a primary symptom, fibrocystic changes in the breast can sometimes lead to discharge, especially if there are associated cysts or fibroadenomas that become irritated or infected.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Breast cancer: Although less common than benign causes, breast cancer can cause nipple discharge, especially if it involves the ducts. It's crucial to investigate any nipple discharge to rule out cancer, particularly if it's bloody, unilateral, and persistent.
- Pituitary adenoma: A prolactinoma, a type of pituitary adenoma, can cause galactorrhea (milk production not associated with childbirth or nursing), which might be mistaken for nipple discharge. This condition can lead to significant hormonal imbalances and requires prompt diagnosis and treatment.
- Rare diagnoses:
- Other endocrine disorders: Besides pituitary adenomas, other endocrine issues can lead to nipple discharge, such as thyroid disorders. These are less common but should be considered in the differential diagnosis, especially if other symptoms are present.
- Infections and inflammatory conditions: Certain infections (like mastitis) or inflammatory conditions of the breast can cause nipple discharge, though these are less common causes compared to the others listed.