Differential Diagnosis for Breast Pain in a Postpartum Woman
- Single most likely diagnosis
- Nipple trauma or nipple fissure: The patient's symptoms of bilateral nipple soreness, worsening pain, and bloody nipple discharge, along with the physical examination findings of open, bloody, linear abrasions on the nipples and areolae, are consistent with nipple trauma or fissure. This condition is common in breastfeeding women, especially in the initial stages of lactation.
- Other Likely diagnoses
- Breast engorgement: The patient's diffusely engorged and mildly tender breasts are consistent with breast engorgement, which is a common condition in the postpartum period, especially in breastfeeding women.
- Mastitis: Although the patient does not have a fever, mastitis is a possible diagnosis, especially given the patient's symptoms of breast pain and tenderness. However, the absence of a fever and the presence of nipple trauma make this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Breast cancer: Although breast cancer is unlikely in a 39-year-old woman with a recent history of pregnancy and breastfeeding, it is essential to consider this diagnosis, especially if the patient's symptoms persist or worsen despite treatment.
- Infectious mastitis (e.g., Staphylococcus aureus): While the patient's temperature is normal, infectious mastitis is a possible diagnosis, and it is crucial to consider this condition, especially if the patient's symptoms worsen or if she develops a fever.
- Rare diagnoses
- Raynaud's phenomenon of the nipple: This condition is characterized by vasospasm of the blood vessels in the nipple, leading to pain and nipple discharge. Although rare, it is essential to consider this diagnosis in breastfeeding women with persistent nipple pain.
- Paget's disease of the breast: This rare condition is characterized by eczematous changes to the nipple and areola, which can be mistaken for nipple trauma or eczema. Although unlikely, it is essential to consider this diagnosis, especially if the patient's symptoms persist or worsen despite treatment.