Differential Diagnosis for Bilateral Axillae Swelling and Tenderness in Pregnancy
- Single Most Likely Diagnosis
- Breast engorgement or mastitis: This condition is common in pregnancy due to hormonal changes, particularly the increase in estrogen and progesterone, which can cause breast tenderness and swelling. The axillary swelling could be referred pain or swelling from the breast tissue that extends into the axillae.
- Other Likely Diagnoses
- Lymphadenopathy due to infection: Infections such as mastitis or localized skin infections can cause lymphadenopathy (swollen lymph nodes) in the axillae, which would be tender.
- Breast cysts or fibroadenomas: These benign breast conditions can become more pronounced or symptomatic during pregnancy due to hormonal changes, potentially causing axillary swelling if they are large enough or if there is referred pain.
- Do Not Miss Diagnoses
- Breast cancer: Although less common, breast cancer can present during pregnancy. It's crucial to consider this diagnosis, especially if there's a palpable mass, significant asymmetry, or if the swelling is unilateral and persistent.
- Lymphoma: Lymphomas can cause lymphadenopathy and are a critical diagnosis not to miss, as they require prompt treatment.
- Deep vein thrombosis (DVT) or pulmonary embolism (PE): While less directly related to axillary swelling, DVT or PE can cause swelling and pain in the arms and are life-threatening conditions that need to be considered, especially in pregnant women who are at higher risk.
- Rare Diagnoses
- Axillary vein thrombosis: This is a rare condition that can cause swelling and pain in the axillae due to a blood clot in the axillary vein.
- Neurogenic causes: Conditions affecting the nerves, such as thoracic outlet syndrome, can cause pain and swelling in the axillae but are less common and might not be directly related to pregnancy.
- Metastatic disease to the axillary lymph nodes: Although rare, it's essential to consider metastasis from other primary cancers, especially if there's a known history of cancer.