Differential Diagnosis for a 74-year-old Female with a Prominent Vein on the Inferior Breast

• Single Most Likely Diagnosis
  • Varicose Vein: This is the most common and likely diagnosis given the presentation. A varicose vein is an enlarged, twisted vein that can appear as a prominent vein, especially in older adults due to decreased vein elasticity and valve function.
• Other Likely Diagnoses
  • Breast Cancer with Venous Obstruction: Although less common, breast cancer can cause a prominent vein due to tumor obstruction of venous return. This would be more concerning and warrants further investigation.
  • Thrombophlebitis: Inflammation of a vein caused by a blood clot, which can make the vein more visible and painful.
  • Superficial Thrombophlebitis: Similar to thrombophlebitis but limited to the superficial veins, which could present as a prominent vein.
• Do Not Miss Diagnoses
  • Invasive Breast Cancer with Skin Involvement: A type of breast cancer that invades the skin, causing changes such as a prominent vein due to tumor growth obstructing normal venous drainage.
  • Superior Vena Cava Syndrome: Although rare, this condition, caused by obstruction of the superior vena cava, can lead to prominent veins on the chest and breast area due to collateral circulation.
• Rare Diagnoses
  • Paget's Disease of the Breast: A rare form of breast cancer that affects the skin of the nipple and, sometimes, the areola. It could potentially cause changes in venous appearance due to skin involvement.
  • Breast Angiosarcoma: A rare and aggressive type of cancer that begins in the cells that line blood vessels or lymph vessels, which could present with prominent veins due to vascular involvement.